Patient education for phosphorus management in chronic kidney disease

Abstract

Objectives:This review explores the challenges and solutions in educating patients with chronic kidney disease (CKD) to lower serum phosphorus while avoiding protein insufficiency and hypercalcemia.Methods:A literature search including terms “hyperphosphatemia,” “patient education,” “food fatigue,” “hypercalcemia,” and “phosphorus–protein ratio” was undertaken using PubMed.Results:Hyperphosphatemia is a strong predictor of mortality in advanced CKD and is remediated via diet, phosphorus binders, and dialysis. Dietary counseling should encourage the consumption of foods with the least amount of inorganic or absorbable phosphorus, low phosphorus-to-protein ratios, and adequate protein content, and discourage excessive calcium intake in high-risk patients. Emerging educational initiatives include food labeling using a “traffic light” scheme, motivational interviewing techniques, and the Phosphate Education Program – whereby patients no longer have to memorize the phosphorus content of each individual food component, but only a “phosphorus unit” value for a limited number of food groups. Phosphorus binders are associated with a clear survival advantage in CKD patients, overcome the limitations associated with dietary phosphorus restriction, and permit a more flexible approach to achieving normalization of phosphorus levels.Conclusion:Patient education on phosphorus and calcium management can improve concordance and adherence and empower patients to collaborate actively for optimal control of mineral metabolism.

Pharmacodynamic Effects of Sucroferric Oxyhydroxide and Sevelamer Carbonate on Vitamin D Receptor Agonist Bioactivity in Dialysis Patients

“…This finding was not unexpected as patients' serum calcium levels were regularly monitored during the study. It is well documented that serum calcium levels are still maintained within a narrow range among patients with CKD, and are therefore not a reliable indicator of calcium balance [11,12. ]…”

Managing serum phosphate in haemodialysis patients: time for an innovative approach?

“…Skills to build self-efficacy through, for example, motivational interviewing have been emphasised as important tools to aid adherence in these patients. 28 Successful strategies are also required to help patients to remember to take phosphate binders as forgetfulness was a major problem with all patients in this study.…”

The importance of nutritional intervention by dietitians for hyperphosphatemia in maintained hemodialysis patients

“…Rather than compelling patients to give up their favorite foods, dietitians aim to provide appropriate recommendations and practical information. For example, rather than eliminating eggs entirely, patients can be advised to instead consume fresh, non-processed egg white (which has a phosphorus-protein ratio less than 2 mg/g), because egg white contains a high amount of essential amino acids and low amounts of fat, cholesterol, and phosphorus [22].…”

“…In healthy individuals, the recommended dietary intake for phosphorus is 1000 mg/day for men and 800 mg/day for women (for further information, see Overview of Dietary intakes for Japanese 2015 [2]). In fact, total dietary phosphorus comes from three different sources which are thought to have different bioavailability and physiologic roles: (1) naturally occurring organic phosphorus, which serves as a component of cell membranes, tissue structures, and phosphoprotein; (2) inorganic phosphorus, which is added during food processing and is present to a lesser extent in naturally occurring phosphorus salts; and (3) inorganic phosphorus present as an active or inactive ingredient in over-the-counter medications, common prescription medications, dietary supplements, and food enrichment/fortification substances ( [22,26]. However, Noori et al noted that there are three important caveats to this plant-based diet.…”