Hyperphosphatemia in dialysis patients: is there a role for focused counseling?

Elevated serum phosphorus (P) and calcium-P product (CaXP) are associated with cardiac mortality in dialysis patients. A CaXP <55 is considered acceptable by most authorities. Because nutrition practices can modulate CaXP, we designed a survey to study the impact of the patients' levels of e...

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Bibliographic Details
Published in:	Journal of renal nutrition Vol. 13; no. 3; p. 219
Main Authors:	Poduval, Rajiv D, Wolgemuth, Christine, Ferrell, Janice, Hammes, Mary S
Format:	Journal Article
Language:	English
Published:	United States 01-07-2003
Subjects:	Calcium Phosphates - blood Counseling Diet - standards Educational Status Feeding Behavior Female Health Knowledge, Attitudes, Practice Humans Hyperkalemia - etiology Hyperparathyroidism, Secondary - etiology Hypertension, Renal - etiology Kidney Failure, Chronic - complications Kidney Failure, Chronic - therapy Male Middle Aged Patient Compliance Patient Education as Topic Phosphates - blood Renal Dialysis - standards Surveys and Questionnaires Treatment Refusal
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Summary:	Elevated serum phosphorus (P) and calcium-P product (CaXP) are associated with cardiac mortality in dialysis patients. A CaXP <55 is considered acceptable by most authorities. Because nutrition practices can modulate CaXP, we designed a survey to study the impact of the patients' levels of education and disease awareness on their CaXP. A survey questionnaire with 5 didactic questions pertaining to hyperphosphatemia and P-binders and 5 questions related to patient attitudes and beliefs was administered to all patients in a hemodialysis unit. The association of CaXP >55 with the patients' level of education, their score on the survey (didactic part, score 0 to 5), parathyroid hormone (PTH) levels, hyperkalemia, hypertension, and vascular disease were studied. Of the 117 patients (61 men, age 56.5 +/- 18 years) who participated in the survey, 49 (42%) had CaXP >55 and 100 (85%) were on P binders. Thirty-seven (31.6%) had at least some college education. Eighty-seven patients (74%) failed to identify foods rich in P; 61% were unaware of complications related to high CaXP. Patients with CaXP >55 were less likely to have college education (20% versus 39%, P =.04), and had lower survey scores (2.4 +/- 1.3 versus 2.6 +/- 1.4, P = NS). Patients with college education scored higher (2.9 +/- 1.1 versus 2.3 +/- 1.4, P =.014). Furthermore, CaXP >55 was significantly associated with hyperkalemia (P =.02), high PTH levels (P <.001), and hypertension (P =.02), but not with >Kt/V, URR, type of hemodialysis access, or vascular diseases. The majority of patients in the survey were ignorant of basic facts pertaining to high P and CaXP. The association of CaXP >55 with hyperkalemia, and not with Kt/V, suggests dietary noncompliance rather than inadequate dialysis. Patients with less education were more likely to have CaXP >55. Because this related mostly to misperception of simple facts that affect dietary habits, there is need for focused counseling of these patients at a level appropriate for their literacy skills.
ISSN:	1532-8503
DOI:	10.1016/S1051-2276(03)00070-0