Managing serum phosphate in haemodialysis patients: time for an innovative approach?

• Published in: European journal of clinical nutrition Vol. 68; no. 3; pp. 392 - 396
• Main Authors: Collinson, A, McMullan, M, Tse, W Y, Sadler, H
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.03.2014; Nature Publishing Group
• Subjects: 692/700/1719; 692/700/565/1950/1544; 692/700/565/2072; Adequacy; Adolescent; Adult; Age; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Calcium; Calcium - blood; Chronic kidney failure; Clinical Nutrition; Dialysis; Education; Emergency and intensive care: renal failure. Dialysis management; Epidemiology; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Health aspects; Hemodialysis; Hemodialysis patients; Humans; Hyperphosphatemia - blood; Hyperphosphatemia - complications; Hyperphosphatemia - prevention & control; Intensive care medicine; Internal Medicine; Kidney diseases; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - complications; Kidneys; Male; Medical personnel; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Nutrient deficiency; Nutritional aspects; original-article; Parameters; Parathyroid; Parathyroid hormone; Parathyroid Hormone - blood; Patients; Phosphate; Phosphates; Phosphates - administration & dosage; Phosphates - blood; Phosphorus; Phosphorus - administration & dosage; Phosphorus - analysis; Public Health; Renal Dialysis; Signs and symptoms; Surveys and Questionnaires; United Kingdom; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Young Adult; United Kingdom; dialysis; serum phosphate; adherence; age; Human; Phosphates; Extrarenal dialysis; Hemodialysis; Metabolic diseases; Serum; Dialysis; Adhesion; Age
• ISSN: 0954-3007; 1476-5640; 1476-5640
• DOI: 10.1038/ejcn.2013.283

Background/Objectives: Hyperphosphataemia, a common biochemical abnormality in chronic kidney disease, poses significant management challenges. This study aims to determine whether the reasons for this are multifactorial; including poor dietary knowledge, poor adherence to a low phosphate diet and phosphate-binding medications and the impact of age on these parameters. Subjects/Methods: In order to compare serum phosphate and other associated parameters to the UK Renal Association Clinical Practice Guidelines 2010 an audit and service evaluation questionnaire was carried out in May 2011 on 130 haemodialysis outpatients attending the Plymouth Dialysis Unit. Results: Fifty-three percent of patients had serum phosphate within the target range of 1.1–1.7 mmol/l, 77% and 85% had serum calcium and parathyroid hormone within target ranges, respectively. Younger patients (18–45years) were significantly less likely to have serum phosphate within range χ 2 (2, n =124)=18.77, P <0.001. Despite better knowledge of their own phosphate levels ( P =0.005), phosphorus-rich foods ( P <0.001), symptoms of hyperphosphataemia ( P <0.001) and increased use of Renal Patient View ( P =0.002), <65 years old had significantly higher phosphate levels than those >65 years ( P <0.001). No significant associations were found between phosphate control and the following factors: gender, timing of dialysis shift, years on dialysis or dialysis adequacy. Conclusions: In this population, despite better knowledge, younger patients have worse phosphate control than older patients. Using the same dietary education techniques may not be suitable for all ages, more innovative approaches supported by skilled health professionals are needed to motivate and engage with younger patients to promote self-management and adherence.