Kidney Res Clin Pract.  2018 Mar;37(1):69-76. 10.23876/j.krcp.2018.37.1.69.

Effects of education on low-phosphate diet and phosphate binder intake to control serum phosphate among maintenance hemodialysis patients: A randomized controlled trial

• Lim E
• Hyun S
• Lee JM
• Kim S
• Lee MJ
• Lee SM
• Oh YS
• Park I
• Shin GT
• Kim H
• Morisky DE
• Jeong JC

• KMID: 2409376
• DOI: http://doi.org/10.23876/j.krcp.2018.37.1.69

Abstract

BACKGROUND
For phosphate control, patient education is essential due to the limited clearance of phosphate by dialysis. However, well-designed randomized controlled trials about dietary and phosphate binder education have been scarce.
METHODS
We enrolled maintenance hemodialysis patients and randomized them into an education group (n = 48) or a control group (n = 22). We assessed the patients' drug compliance and their knowledge about the phosphate binder using a questionnaire.
RESULTS
The primary goal was to increase the number of patients who reached a calcium-phosphorus product of lower than 55. In the education group, 36 (75.0%) patients achieved the primary goal, as compared with 16 (72.7%) in the control group (P = 0.430). The education increased the proportion of patients who properly took the phosphate binder (22.9% vs. 3.5%, P = 0.087), but not to statistical significance. Education did not affect the amount of dietary phosphate intake per body weight (education vs. control: −1.18 ± 3.54 vs. −0.88 ± 2.04 mg/kg, P = 0.851). However, the dietary phosphate-to-protein ratio tended to be lower in the education group (−0.64 ± 2.04 vs. 0.65 ± 3.55, P = 0.193). The education on phosphate restriction affected neither the Patient-Generated Subjective Global Assessment score (0.17 ± 4.58 vs. −0.86 ± 3.86, P = 0.363) nor the level of dietary protein intake (−0.03 ± 0.33 vs. −0.09 ± 0.18, P = 0.569).
CONCLUSION
Education did not affect the calcium-phosphate product. Education on the proper timing of phosphate binder intake and the dietary phosphate-to-protein ratio showed marginal efficacy.

Keyword

Compliance; Hemodialysis; Hyperphosphatemia; Phosphates

MeSH Terms

Body Weight
Compliance
Dialysis
Diet*
Dietary Proteins
Education*
Humans
Hyperphosphatemia
Patient Education as Topic
Phosphates
Renal Dialysis*
Dietary Proteins
Phosphates