Multidisciplinary education approach to optimize phosphate control among hemodialysis patients
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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.
KeywordsEducation 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.
- 1.Hooi LS, Mushahar L, Ong LM, Visvanathan R, Wong HS, editors. Clinical practice guidelines: renal replacement therapy. 4th ed. Kuala Lumpur: Post Graduate Renal Society of Malaysia; 2017.Google Scholar
- 2.Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl. 2017;7(2017):1–59.Google Scholar
- 3.Malaysian Society of Nephrology. 23rd Report of the Malaysian dialysis and transplant registry. Kuala Lumpur: Malaysian Society of Nephrology; 2015.Google Scholar
- 6.Joseph AC. Control of hyperphosphatemia among patients with ESRD. J Am Soc Nephrol. 2005;16(11):S107–14.Google Scholar
- 10.Arenas MD, Malek T, Gil MT, Moledous A, Alvarez-Ude F, Reig-Ferrer A. Challenge of phosphorus control in hemodialysis patients: a problem of adherence? J Nephrol. 2010;23(5):525–34.Google Scholar
- 11.de Brito‐Ashurst I, Dobbie H. A randomized controlled trial of an educational intervention to improve phosphate levels in hemodialysis patients. J Ren Nutr Off J Counc Ren Nutr Natl Kidney Found. 2003;13(4):267–74.Google Scholar
- 12.Gardulf A, Pålsson M, Nicolay U, Swedish Renal Nurse Group. Education for dialysis patients lowers long-term phosphate levels and maintains health-related quality of life. Clin Nephrol. 2011;75(4):319–27.Google Scholar
- 13.Van Camp YP, Huybrechts SA, Van Rompaey B, Elseviers MM. Nurse-led education and counselling to enhance adherence to phosphate binders. J Clin Nurs. 2011;21(9–10):1304–13.Google Scholar
- 17.Hughes J, Tenni P, Soulsby N. Case studies in clinical practice: use of laboratory test data: process guide and reference for healthcare professionals. 2nd ed. Melbourne: Pharmaceutical Society of Australia; 2009.Google Scholar
- 20.Noori N, Sims JJ, Kopple JD, et al. Organic and inorganic dietary phosphorus and its management in chronic kidney disease. Iran J Kidney Dis. 2010;4(2):89–100.Google Scholar