Dietitian-Led Education Program to Improve Phosphate Control in a Single-Center Hemodialysis Population
Objective
We sought to analyze the effect of a structured, dietitian-led education program on patients' general knowledge of phosphate and phosphate binders, and its impact on serum phosphate concentrations in a single-center hemodialysis population.
Design
We compared subjects before and after intervention.
Setting
This study involved two dialysis units operated by a single center.
Patients
One hundred and fifteen hemodialysis patients consented to participate in this study (54% male; mean age, 61.1 years; 32% Asian). Patients acted as their own controls. One hundred and eight patients completed the study.
Intervention
All patients completed a questionnaire to assess their knowledge of phosphate and phosphate-binder therapy. Small group teaching sessions were then delivered to patients by a single dietitian, with the aid of a hospital interpreter as required. Patients also received information booklets or audio cassettes translated into Urdu. A second identical questionnaire was completed a month later.
Main Outcome Measures
Outcome measures involved pre-education and posteducation knowledge scores, monthly measurements of serum phosphate, calcium, and mean Kt/V, and parathyroid hormone concentrations every 3 months during the 5 month run-in period and subsequent 5-month study period.
Results
The education program significantly improved patients' general knowledge of phosphate and of phosphate-binders (P < .001), especially in patients with a low pretest score and those of South Asian origin. This result was associated with a significant reduction in serum phosphate in patients with hyperphosphatemia (P = .032).
Conclusions
These findings suggest that a combination of educational initiatives is effective in enhancing patients' knowledge of phosphate and phosphate-binders, and consequently in improving serum phosphate levels in patients with hyperphosphatemia.
∗Department of Renal Medicine, Bradford Teaching Hospitals National Health Service Trust, St. Luke's Hospital, Bradford, United Kingdom
†School of Health Studies, University of Bradford, Bradford, United Kingdom
Address reprint requests to Veena Reddy, MBBS, MRCP, PhD, Department of Renal Medicine, Northern General Hospital, Herries Road, Sheffield, S5 7AU, United Kingdom.
ABSTRACT