Multidisciplinary education approach to optimize phosphate control among hemodialysis patients

Abstract

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.

Keywords: Education; Hemodialysis; Malaysia; Mineral bone disease; Multidisciplinary; Phosphate.