Multidisciplinary education approach to optimize phosphate control among hemodialysis patients

  • Meei Wah Chan
  • Huey Miin CheahEmail author
  • Madihah Binti Mohd Padzil
Research Article


Background Hyperphosphatemia is a common consequence in end stage renal disease. It is associated with increased cardiovascular risk and mortality, also development of hyperparathyroidism and mineral bone disease. A patient educational program involving physician, pharmacist and dietician was developed to manage hyperphosphatemia among hemodialysis patients. Objective To investigate the efficacy of the program in optimal phosphate control among hemodialysis patients. Setting Kuala Lipis Hospital, Malaysia. Method This was a non-randomized, single-arm community trial running for a period of 6 months. The program consisted of a small group seminar and individual counseling sessions. Two individual counseling sessions were conducted for each patient, focusing on diet and medication adherence, by an accredited dietician and pharmacist respectively. The group seminar was delivered by a multidisciplinary team involving a physician, pharmacist and dietician. Topics included basic knowledge of hyperphosphatemia, phosphate binder and dietary phosphate control. Eligible and consented patients had knowledge and medication adherence assessment, measurement of pre-dialysis serum calcium, albumin, phosphate, haemoglobin and alkaline phosphatase before and after the educational program. Main outcome measure Phosphate level, knowledge and medication adherence assessment. Results Fifty-seven patients completed the program and were included into final data analysis. The median (IQR) phosphate level (mmol/L) was 1.86 (1.45–2.24) before and decreased to 1.47 (1.21–1.91) and 1.49 (1.28–1.81) 3 months and 6 months after PEP (p < 0.001). The percentage of patients with uncontrolled phosphate level was reduced from 59.3 to 35.6% and 42.1% after the PEP (p = 0.003). The mean knowledge score almost doubled after the intervention, with a mean pre-score of 8.61 (95% CI 7.85–9.37) to mean post-score of 15.31 (95% CI 14.85–15.76). The adherence to phosphate binder also improved from 17.2 to 41.4% after PEP (p = 0.007). Conclusion A multidisciplinary patient education program is an effective approach to manage hyperphosphatemia among hemodialysis patients in Malaysia.


Education Hemodialysis Malaysia Mineral bone disease Multidisciplinary Phosphate 



We would like to thank the Director General of Health Malaysia for his permission to publish this article. We would like to extend our heartfelt gratitude to the staff at haemodialysis unit Kuala Lipis Hospital especially Weng Yik Ho, Lay Hsien Tan and Md Yusseri bin Yasin for their hard work at making the patient educational program a success. Special thanks also to Bee Chiu Lim from Clinical Research Centre Malaysia for her advice with statistical analysis.


No specific funding was received from agencies in the public, commercial, or not-for-profit sectors.

Conflicts of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of General MedicineKuala Lipis HospitalKuala LipisMalaysia
  2. 2.Department of PharmacyKuala Lipis HospitalKuala LipisMalaysia
  3. 3.Department of Dietary and NutritionKuala Lipis HospitalKuala LipisMalaysia
  4. 4.Department of PharmacySultan Haji Ahmad Shah HospitalTemerlohMalaysia

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