A service review to assess if innovative intensive phosphate dietary education can help reduce phosphate levels to the recommended range in a hemodialysis population.

Abstract

Studies suggest that hemodialysis (HD) patients are less likely to adhere to phosphate dietary restriction than to potassium, sodium, or fluid restriction. It is particularly important that dietary education is provided appropriately, consistently, and reinforced regularly to encourage compliance with diet and phosphate-binder regimens. Patient awareness of the consequences of a chronically raised phosphate and its treatment is associated with lower serum phosphate levels. The aim of this study was to assess the impact of a structured educational program on patient knowledge and control of serum phosphate in a maintenance HD population. Thirty-six patients with a phosphate level >1.7 mmol/L for the previous 3 months were assessed. A phosphate knowledge questionnaire was devised by the authors and completed by the patient group. This focused on patient knowledge of dietary sources of phosphate and complications of high phosphate levels. The education program was divided into three modules and was based around diet, phosphate additives, and complications of hyperphosphatemia. Visual aids, oral, and written information were provided to each patient throughout the sessions. Seventeen patients completed the education sessions. The knowledge and food frequency questionnaire were repeated at the end of the modules to assess change. Phosphate levels dropped from an average of 2.12-1.73 mmol/L over the education period with a significance level of P = 0.000481 (significant if P < 0.001). This average falls in line with recommended guidelines. Knowledge questionnaire results improved overall. This education program displayed excellent outcomes with an overall reduction in phosphate levels and an improved phosphate knowledge among our sampled HD population. This education program shows that discovering novel ways of education is crucial to enhancing dietetic practice with renal dietitians best placed to deliver patient specific phosphate education.