Nutritional education for the management of osteodystrophy (nemo) in patients on haemodialysis: a randomised controlled trial. Determinants of Compliance Behaviours among Patients Undergoing Hemodialysis in Malaysia Effect of food additives on hyperphosphatemia among patients with end-stage renal disease: a randomized controlled trial. Immediate and delayed memory recall patterns of chronic hemodialysis adult hispanic patients. More Dietetic Time, Better Outcome? The effect of diet education on the laboratory values and knowledge of hemodialysis patients with hyperphosphatemia. Dietary habits and counseling focused on phosphate intake in hemodialysis patients with hyperphosphatemia. Evaluation of a phosphate management protocol to achieve optimum serum phosphate levels in hemodialysis patients. Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). A randomized controlled trial of an educational intervention to improve phosphate levels in hemodialysis patients. The impact of nutrition intervention on quality of life in pre-dialysis chronic kidney disease patients. Dietary and fluid compliance: an educational intervention for patients having haemodialysis. Results of a pilot program to improve phosphorus outcomes in hemodialysis patients. Patient Education: An Efficient Adjuvant Therapy for Hyperphosphatemia in Hemodialysis Patients Effectiveness of a nurse-led intensive educational programme on chronic kidney failure patients with hyperphosphataemia: randomised controlled trial.
OBJECTIVE To examine the effect of self-management dietary counselling ( SMDC ) on adherence to dietary management of hyperphosphatemia among haemodialysis patients . DESIGN An eight-week cluster based r and omised control trial . PARTICIPANTS 122 stable adult patients were recruited from an HD unit in Sidon , Lebanon . Study groups were : full intervention ( A ) ( n = 41 ) , partial intervention ( B ) ( n = 41 ) and control ( C ) ( n = 40 ) . INTERVENTION Group ( A ) received SMDC , Group ( B ) received educational games only and Group ( C ) did not receive any research intervention . MAIN OUTCOME MEASURES Serum phosphorus ( P ) , Calcium Phosphate product ( Ca × P ) and two question naires : patient knowledge ( PK ) and dietary non-adherence ( PDnA ) to P reduced diet . RESULTS Group A experienced a significant improvement in mean ( ± SD ) P ( 6.54 ± 2.05 - 5.4 ± 1.97 mg/dl ) , Ca × P ( 58 ± 17 - 49 ± 12 ) , PK scores ( 50 ± 17 - 69 ± 25 % ) and PDnA scores ( 21.4 ± 4.0 - 18.3 ± 2.0 ) . Group B experienced a significant improvement in Ca × P ( 52 ± 14 - 45 ± 16 ) . Group C did not experience any significant change post intervention . CONCLUSION Our findings demonstrate the importance of patient-tailored counselling on serum P management Background Patients with end stage renal disease often fail to follow prescribed dietary and fluid regimen , leading to undesirable outcomes . This study aim ed to examine and identify factors influencing dietary , fluid , medication and dialysis compliance behaviours in patients undergoing hemodialysis . Methods This was a cross-sectional study which employed purposive sampling design . A total of 188 respondents were recruited from 14 dialysis centres in Malaysia between 2008–2011 .  Self-reported compliance behaviours and biochemical measurements were used as evaluation tools . Results Compliance rates  of dietary , fluid , medication and dialysis were 27.7 % , 24.5 % , 66.5 % and 91.0 % , respectively . Younger , male , working patients and those with longer duration on hemodialysis were found more likely to be non-compliant . Lacks of adequate knowledge , inadequate self-efficacy skills , forgetfulness and financial constraints were the major perceived barriers towards better compliance to fluid , dietary , medication and dialysis , respectively . Conclusions Healthcare professionals should recognise the factors hindering compliance from the patients ' perspective while assisting them with appropriate skills in making necessary changes possible CONTEXT High dietary phosphorus intake has deleterious consequences for renal patients and is possibly harmful for the general public as well . To prevent hyperphosphatemia , patients with end-stage renal disease limit their intake of foods that are naturally high in phosphorus . However , phosphorus-containing additives are increasingly being added to processed and fast foods . The effect of such additives on serum phosphorus levels is unclear . OBJECTIVE To determine the effect of limiting the intake of phosphorus-containing food additives on serum phosphorus levels among patients with end-stage renal disease . DESIGN , SETTING , AND PARTICIPANTS Cluster r and omized controlled trial at 14 long-term hemodialysis facilities in northeast Ohio . Two hundred seventy-nine patients with elevated baseline serum phosphorus levels ( > 5.5 mg/dL ) were recruited between May and October 2007 . Two shifts at each of 12 large facilities and 1 shift at each of 2 small facilities were r and omly assigned to an intervention or control group . INTERVENTION  Intervention participants ( n=145 ) received education on avoiding foods with phosphorus additives when purchasing groceries or visiting fast food restaurants . Control participants ( n=134 )  continued to receive usual care . MAIN OUTCOME MEASURE Change in serum phosphorus level after 3 months . RESULTS At baseline , there was no significant difference in serum phosphorus levels between the 2 groups . After 3 months , the decline in serum phosphorus levels was 0.6 mg/dL larger among intervention vs control participants ( 95 % confidence interval , -1.0 to -0.1 mg/dL ) . Intervention participants also had statistically significant increases in reading ingredient lists ( P<.001 ) and nutrition facts labels ( P = .04 ) but no significant increase in food knowledge scores ( P = .13 ) . CONCLUSION Educating end-stage renal disease patients to avoid phosphorus-containing food additives result ed in modest improvements in hyperphosphatemia . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00583570 OBJECTIVE To determine the most effective time to administer nutrition education to hemodialysis patients by evaluating memory recall scores before , during , and after treatment . DESIGN Prospect i ve , quasi experimental cohort . SUBJECTS Sixty-two adult Hispanic hemodialysis patients ( 38 men and 24 women , 29 < 65 years of age and 32 > 65 years of age ) . Patients , between 18 and 85 years of age , who have been on hemodialysis at least one month . Patients were literate and able to see and hear without impairment . SETTING Hemodialysis clinic . INTERVENTION Fifteen simple words ( English and Spanish ) in large print on 5 x 8 laminated 2-sided cards that were shown to the patient before , during , and after dialysis . METHODS Patients were shown 5 different words before going on dialysis , 5 more words during dialysis , and 5 more words after dialysis . Each time , the patient was asked for immediate recall to assess short-term memory recall . Patients were then asked 5 to 10 minutes later ( before , during , and after dialysis ) what words were seen to assess long-term memory recall . MAIN OUTCOME MEASURE Did patients remember more before , during , or after dialysis ? RESULTS There were no significant differences in memory recall scores between diabetic and nondiabetic subjects or by gender with respect to memory recall scores . Results imply that time of recall in relation to dialysis treatment may be important for those above 65 years of age . A significant difference was found when comparing those subjects completing elementary school to those subjects completing high school and college . The evidence found in this study was in accordance with the findings of Smith and Winslow in their 1990 study showing subjects required less time to complete a task measuring cognitive function when it was given before hemodialysis treatment , as compared with during the treatment . CONCLUSION As age increases , recall ability likely will decrease . As education level increases , recall ability will likely increase . Providing nutrition education before the hemodialysis treatment occurs may be more beneficial than during and after the treatment . The educational information that a hemodialysis patient retains after treatment may be seriously impacted by the patient 's education level and age Background / Aim : A r and omized controlled trial was conducted involving 67 stable adult haemodialysis patients with hyperphosphataemia . The objective was to determine the effect of monthly dietetic consultations on patients ’ serum phosphate concentrations and calcium × phosphate product . Methods : The intervention group received monthly dietetic consultations for 6 months using advanced counselling skills aim ed at limiting phosphate intake in the diet and improving compliance with phosphate binders , whereas st and ard care with dietetic consultations every 6 months was provided to the control group .  Results : Serum phosphate concentrations decreased in the intervention group from 2.05 ± 0.48 to 1.80 ± 0.48 mmol/l by month 3 ( p < 0.05 ) . However , this subsequently increased and by month 6 there was no significant difference from baseline . After controlling for confounding variables , the difference between the groups was approaching significance at month 3 , but there was no difference by month 6 , or following conclusion of the study . The calcium × phosphate product similarly decreased in both groups , achieving K/DOQI st and ards , but was not sustained either during the remainder of the study but decreased further by the 12-month follow-up and , although it was not significantly different , it did improve significantly from baseline in both the intervention and control groups . Conclusion : Increased frequency of dietetic consultations can result in improved phosphate control in the short term , and therefore more innovative strategies appear necessary to sustain longer-term control OBJECTIVE The purpose of this study was to evaluate the effectiveness of 20 to 30 minutes per month of additional diet education on monthly laboratory values ( phosphorus , calcium , parathyroid hormone , and calcium/phosphorus product ) and knowledge of dietary phosphorus management in hemodialysis patients with hyperphosphatemia . DESIGN A quasi-experimental design . SETTING Three outpatient dialysis centers owned by the same corporation in 1 southern state . PATIENTS Based on a 3-month average serum phosphorus > 6.0 mg/dL , 70 patients were selected for participation ; 63 dialysis patients completed the study , 32 in the experimental group and 31 in the control group . INTERVENTION All patients completed a before- and -after knowledge test and had monthly blood sample s drawn . Each month , the same registered dietitian provided the routine laboratory results review with control group . The experimental group received the routine laboratory review plus 20 to 30 minutes of additional diet education specifically targeting phosphorus . Main outcome measures Before- and -after knowledge test results and baseline and final serum calcium , phosphorus , parathyroid hormone , and calcium/phosphorus product levels . RESULTS At baseline , there were no significant differences in any of the laboratory values , but the knowledge level of the experimental group was greater ( P < .05 ) After 6 months , gains in knowledge were significantly higher in the intervention group , and the serum phosphorus and calcium/phosphorus product levels were significantly lower ( P < .01 ) than in the control group . CONCLUSION Based on this research , those patients who received extra education monthly showed positive changes , which may be beneficial in reducing hyperphosphatemia OBJECTIVE To evaluate the dietary habits of hemodialysis patients with hyperphosphatemia and the effects of a dietetic intervention focused on limiting dietary phosphate load . DESIGN Cross-sectional dietary evaluation and prospect i ve intervention study . SETTING Hospital hemodialysis units of Pisa and Pistoia , Italy . Subjects Forty-three stable adult hemodialysis patients , 20 of whom had phosphorus serum levels > 5.5 mg/dL. INTERVENTION Analysis of dietary composition and of the effects of individual dietetic counseling in an attempt to reduce phosphorus intake while preserving the same protein intake . MAIN OUTCOME MEASURES Differences in nutrient intake between normophosphatemic and hyperphosphatemic patients , and changes in dietary phosphorus and phosphorus-protein ratio , serum phosphate , and calcium-phosphate product after dietetic intervention . RESULTS No major differences in nutrient intake were detected between hyperphosphatemia and normophosphatemia patients , apart from a lower phosphorus-protein ratio ( 13.1 + /- 1.7 versus 14.1 + /- 2.1 mg/g , P < .05 ) in the former . After dietetic intervention in the hyperphosphatemia patients , phosphate and calcium intake decreased significantly ( by 100 mg on average ) , whereas dietary protein did not change . A further decrease of the dietary phosphate-protein ratio ( 12.5 + /- 1.8 mg/g , P < .05 ) also occurred . Serum phosphate showed a trend to decrease in the intervention group , whereas the serum calcium-phosphate product decreased significantly ( from 66.8 + /- 13.1 to 61.0 + /- 13.8 mg2 /dL2 , P < .05 ) . CONCLUSIONS In compliant and motivated patients , individual dietetic counseling may be useful in reducing phosphate load and in limiting the phosphate burden related to an adequate protein intake , with a potentially favorable impact on calcium-phosphate retention . A phosphate-controlled diet has a role in an integrated therapeutic approach to hyperphosphatemia and positive calcium-phosphorus balance in hemodialysis patients OBJECTIVE To evaluate the effectiveness of a protocol design ed to optimize serum phosphate levels in patients undergoing regular hemodialysis ( HD ) . DESIGN R and omized , controlled trial . SETTING Hemodialysis units at Barts and the London NHS Trust and satellite units . PATIENTS Thirty-four clinical ly stable adults undergoing regular HD with a serum phosphate level > 1.8 mmol/L on at least one occasion within 4 months of starting the study . INTERVENTION Management of serum phosphate using a specially design ed phosphate management protocol during a 4-month study period implemented by a renal dietitian and renal pharmacist compared with st and ard practice . MAIN OUTCOME MEASURE Change in serum phosphate levels in both groups after 4 months . RESULTS Patients managed using the phosphate management protocol had a significantly greater reduction in serum phosphate levels compared with patients receiving st and ard practice ( -0.22 + /- 0.67 mmol/L vs. + 0.19 + /- 0.32 mmol/L , P = 0.03 ) . CONCLUSION The phosphate management protocol was effective , and its implementation was associated with significantly better serum phosphate control in patients undergoing regular HD BACKGROUND Abnormalities in serum calcium , phosphorus , and parathyroid hormone ( PTH ) concentrations are common in patients with chronic kidney disease and have been associated with increased morbidity and mortality . No clinical trials have been conducted to clearly identify categories of calcium , phosphorus , and PTH levels associated with the lowest mortality risk . Current clinical practice guidelines are based largely on expert opinions , and clinical ly relevant differences exist among guidelines across countries . We sought to describe international trends in calcium , phosphorus , and PTH levels during 10 years and identify mortality risk categories in the Dialysis Outcomes and Practice Patterns Study ( DOPPS ) , an international study of hemodialysis practice s and associated outcomes . STUDY DESIGN Prospect i ve cohort study . PARTICIPANTS 25,588 patients with end-stage renal disease on hemodialysis therapy for longer than 180 days at 925 facilities in DOPPS I ( 1996 - 2001 ) , DOPPS II ( 2002 - 2004 ) , or DOPPS III ( 2005 - 2007 ) . PREDICTORS Serum calcium , albumin-corrected calcium ( Ca(Alb ) ) , phosphorus , and PTH levels . OUTCOMES Adjusted hazard ratios for all-cause and cardiovascular mortality calculated using Cox models . RESULTS Distributions of mineral metabolism markers differed across DOPPS countries and phases , with lower calcium and phosphorus levels observed in the most recent phase of DOPPS . Survival models identified categories with the lowest mortality risk for calcium ( 8.6 to 10.0 mg/dL ) , Ca(Alb ) ( 7.6 to 9.5 mg/dL ) , phosphorus ( 3.6 to 5.0 mg/dL ) , and PTH ( 101 to 300 pg/mL ) . The greatest risk of mortality was found for calcium or Ca(Alb ) levels greater than 10.0 mg/dL , phosphorus levels greater than 7.0 mg/dL , and PTH levels greater than 600 pg/mL and in patients with combinations of high-risk categories of calcium , phosphorus , and PTH . LIMITATIONS Because of the observational nature of DOPPS , this study can only indicate an association between mineral metabolism categories and mortality . CONCLUSIONS Our results provide important information about mineral metabolism trends in hemodialysis patients in 12 countries during a decade . The risk categories identified in the DOPPS cohort may be relevant to efforts at international harmonization of existing clinical guidelines for mineral metabolism OBJECTIVE To determine the effect of a dietetic educational intervention on phosphate and calcium levels of hemodialysis patients . DESIGN Parallel-group r and omized controlled trial . SETTING Teaching hospital hemodialysis unit in London , Engl and . PATIENTS Fifty-six stable adult hemodialysis patients with hyperphosphatemia . INTERVENTION An educational intervention and one-to-one teaching session given by a renal dietitian , attempting to improve patients ' knowledge of phosphate management and their compliance with diet and medication . OUTCOME MEASUREMENT Patients ' serum phosphate , calcium , and calcium x phosphate products in the 3 months after the intervention , compared with those before the intervention . Results were also compared with a control group that had not undergone the intervention . RESULTS In the intervention group , serum phosphate was significantly reduced after the education session , as compared with the results previously . In the control group , there was no significant change in serum phosphate level . The improved results were sustained over a period of 3 months . Serum calcium increased in the intervention group , but this result was not significant . There was an improvement in the calcium-phosphate product in the intervention group , but again this was not significant . CONCLUSION Dietetic educational intervention can favorably alter patients ' serum phosphate levels , with potential impact on morbidity and mortality BACKGROUND & AIMS Uraemic symptoms as a result of reduced kidney function may impact on an individual 's functional and nutritional status . This study aims to investigate whether providing individualised nutritional counselling can improve nutritional status and influence quality of life in pre-dialysis chronic kidney disease patients . METHODS Fifty-three stage IV and V pre-dialysis chronic kidney disease patients underwent assessment of  nutritional status  ( by Patient Generated Subjective Global Assessment ) and  quality of life  ( by Kidney Disease Quality of Life ) . Participants were assessed at baseline and following a 12-week r and omised-controlled treatment , allocated to either individualised counselling with regular follow-up ( n=24 ) or st and ard care treatment ( generic education only ( n=23 ) ) . RESULTS At baseline , nutritional status was significantly correlated with all general quality of life sub-scales . There was a statistically significant mean difference in change between groups for : symptoms of kidney disease ( 7.1 ( 0.1 - 14.1 ) p=0.047 ) ; cognitive functioning ( 14.6 ( 5.4 - 23.7 ) p=0.003 ) ; and vitality ( 12.0 ( 4.6 - 19.5 ) p=0.002 ) favouring intervention treatment . CONCLUSIONS Quality of life is related to nutritional status in pre-dialysis patients . Providing individualised nutritional counselling improves many components of quality of life , compared with st and ard nutrition care , in the stage prior to dialysis treatment AIM This paper is a report of a study conducted to determine the effect of an educational intervention on dietary and fluid compliance in patients having haemodialysis . BACKGROUND Many of the clinical problems experienced by patients having haemodialysis are related to their failure to eat appropriate foods and restrict their fluid intake . Educational intervention in patients having haemodialysis to improve their compliance with dietary and fluid restrictions appears to be effective . METHODS Sixty-three patients having haemodialysis in three general hospitals in Tehran , Iran , were allocated into two groups at r and om for oral and /or video education . They were asked to give demographic and medical data . Bimonthly average values of serum potassium , sodium , calcium , phosphate , albumin , creatinine , uric acid , and blood urea nitrogen and interdialytic weight gain were measured before and after the teaching programmes . The data were collected in 2007 . FINDINGS Compliance in terms of biochemical parameters and interdialytic weight gain was observed in 63.5 % and 76.2 % of patients in the oral and video teaching groups respectively . Statistically significant correlations were observed between demographic variables ( age , educational level and occupation ) and dietary and fluid compliances ( P < 0.001 ) . There was no difference between the effectiveness of two educational interventions . CONCLUSION Nurses should emphasize sodium compliance in patients having haemodialysis and explain its adverse effects , such as excessive weight gain , hypertension , and peripheral oedema OBJECTIVE End-stage renal disease causes dysregulation of bone and mineral metabolism , including increased serum phosphorus levels . Kidney Foundation Kidney Disease Outcome Quality Initiative 2003 guidelines recommend maintaining phosphorus levels between 3.5 and 5.5 mg/dL in dialysis patients . We examined the effects of a focused phosphorus management pilot program design ed to improve the percentage of hemodialysis patients achieving phosphorus levels < 5.5 mg/dL. DESIGN , SETTING , SUBJECTS , AND INTERVENTION : We conducted a prospect i ve , multicenter , single-arm study at 8 geographically diverse at-risk facilities ( n = 702 hemodialysis patients ) in a large U.S. dialysis organization . The focused phosphorus management program provided in-service training to staff members , and provided patients with diet and phosphorus management through in-center , 1:1 education and support , direct-to-patient adherence communications , benefit management assistance , and adherence support specific to lanthanum carbonate over a 6-month period . MAIN OUTCOME MEASURE Facility-level markers of bone and mineral metabolism ( phosphorus , parathyroid hormone , corrected calcium ) and nutritional status ( serum albumin , normalized protein catabolic rate ) were assessed before and after program implementation . RESULTS There was a significant increase in the percentage of patients per facility achieving phosphorus levels < 5.5 mg/dL ( mean ± SD at baseline = 61.6 % ± 5.2 % ; month 6 = 71.3 % ± 9.0 % ; P < .01 ) and parathyroid hormone ( 150 to 300 pg/mL ; mean ± SD at baseline = 39.1 % ± 2.4 % ; month 6 = 44.5 % ± 7.0 % ; P = .04 ) . During the course of the evaluation , mean calcium , albumin , and normalized protein catabolic rate levels did not change significantly . CONCLUSIONS These results show proof-of-concept that a focused phosphorus management program targeting both staff members and patients can significantly improve patient outcomes without compromising nutritional status Background . Hemodialysis and phosphate ( P ) binder therapy are the major methods to reduce the phosphate level in dialysis patients . However , dietary P restriction is necessary for adequate control . The successful dietary control is based on patient compliance . Patient education is the best method to assure the knowledge and drive of dietary control , which are the key features for patient compliance . The aim of the study is to investigate quantitatively the effect of patient education on serum P levels in hyperphosphatemic hemodialysis patients . Methods . We conducted a prospect i ve self-control study . Fifty hemodialysis patients with a pre-dialysis serum P level greater than 6.0 mg/dL were studied .  Intensified patient education was given . Serum P , calcium ( Ca ) , and intact parathyroid hormone ( iPTH ) were evaluated before and one month after patient education . Results . Thirty-six ( 72 % ) patients had improved pre-dialysis P level ( pre-education : 7.50 ± 1.33 ; post-education : 5.85 ± 1.20 mg/dL , p < 0.001 ) and Ca × P product ( pre-education : 68.17 ± 12.70 ; post-education : 54.70 ± 11.87 mg2/dL2 , p < 0.001 ) . The effect lasted for at least three months . There is no significant change on calcium levels . The only predictor of a successful patient education is the iPTH level ( improved : 348.8 ± 277.6 ; non-improved : 668.0 ± 674.1 ng/mL , p = 0.021 ) . Conclusions . Patient education could be helpful and efficient in hyperphosphatemic control in dialysis patients . The patient education should be given before the serum iPTH level getting high AIMS AND OBJECTIVES To prospect ively evaluate the effects of a nurse-led educational intervention on the management of hyperphosphataemia as well as knowledge of phosphate among patients with end-stage renal disease . BACKGROUND Haemodialysis and phosphate binder therapy are the major methods used to reduce the phosphate level in dialysis patients . However , patient education related to hyperphosphataemia , diet and phosphate binders may be another important factor associated with the success of the control of the hyperphosphataemia . DESIGN This prospect i ve r and omised controlled trial was conducted during the period from June 2009-March 2011 at the HD units of two hospitals in Tianjin , China . METHODS A total of 80 participants were r and omly assigned to experimental group ( n=40 ) and control group ( n=40 ) . Participants in the experimental group received the nurse-led intensive educational programme , including individualised education and educational session about diet and medicine regimes , etc . , while participants in the control group received the routine guidance . RESULTS There were statistically significant differences between the study groups in decline in serum phosphorus and calcium-phosphorus product levels and improvement in patients ' general knowledge three months postintervention , and these differences sustained until the end of the study . Increased serum calcium level was observed both in the experimental group and in the control group , but there was no significant difference between groups . No statistical significance was found regarding serum albumin level between the groups . No significant difference in the serum parathyroid hormone level was found between the groups by month 6 . CONCLUSIONS Nurse-led intensive educational programme plays an important role in the control of hyperphosphataemia among patients with end-stage renal disease . RELEVANCE TO CLINICAL PRACTICE Chronic kidney failure patients with hyperphosphataemia are more likely to benefit from nurse-led intensive educational programmes
Strategies to enhance knowledge of and adherence to dietary guidelines for management of  hyperphosphatemia in hemodialysis patients have been studied extensively over the past decade .
This review is the first to compile all of them ( 2003 - 2013 ) and conduct a meta- analysis through calculation of effect size , with the aim of identifying the optimal nutrition education methods for effective management of hyperphosphatemia in hemodialysis patients .