Abstract
Hyperphosphatemia has been associated with the development of secondary hyperparathyroidism, renal osteodystrophy, cardiovascular calcification and increased risk of death. Using a one group, pretest-posttest study design, we sought to evaluate changes in serum phosphorus, calcium, parathyroid hormone and subject knowledge in response to a 3-month educational intervention. Mean serum phosphorus levels did not differ significantly between the three evaluation periods: pretreatment (5.69 mg/dl), treatment (5.84 mg/dl) and posttreatment (6.17 mg/dl). Mean serum calcium, calcium-phosphorus product and PTH values also did not differ significantly between the treatment periods. We observed no difference between the subject test scores between the two testing periods. Calcium-phosphorus product, serum phosphorus and PTH values on average, despite the education program, remained outside the K/DOQI target guidelines 44, 56 and 81% of the time, respectively. The results of this study suggest that an aggressive 3-month patient education program targeting dietary phosphorus knowledge, phosphate binder name and dosing, and knowledge of medical consequences associated with non-compliance had no effect on the serum phosphorus, calcium, PTH or phosphate binder need.
Similar content being viewed by others
References
Leggat JE Jr, Orzol SM, Hulbert-Shearon TE, Golper TA, Jones CA, Held PJ et al (1998) Noncompliance in hemodialysis: predictors and survival analysis. Am J Kidney Dis 32:139–145
Bernardini J, Nagy M, Piraino B (2000) Pattern of noncompliance with dialysis exchanges in peritoneal dialysis patients. Am J Kidney Dis 35:1104–1110
Tomasello S, Dhupar S, Sherman R (2004) Phosphate binders, K/DOQI guideline, and compliance: the unfortunate reality. Dial Transplant 33:236–242
Wolcott DL, Maida CA, Diamond R, Nissenson AR (1986) Treatment compliance in end-stage renal disease patients on dialysis. Am J Nephrol 6:329–338
Lamping DL, Campbell, KA (1990) Hemodialysis compliance: assessment, prediction, and intervention (part I). Semin Dial 3:52–56
Lamping DL, Campbell, KA (1990) Hemodialysis compliance: assessment, prediction, and intervention (part II). Semin Dial 3:105–111
Curtin RB, Svarstad BL, Andress D, Keller T, Sacksteder P (1997) Differences in older versus younger hemodialysis patients’ noncompliance with oral medications. Geriatr Nephrol Urol 7:35–44
Curtin RB, Svarstad BL, Keller TH (1999) Hemodialysis patients’ noncompliance with oral medications. Anna J 26:307–317, 335
Cleary DJ, Matzke GR, Alexander AC, Joy MS (1995) Medication knowledge and compliance among patients receiving long-term dialysis. Am J Health Syst Pharm 52:1895–1900
Blanchard R, Berger W, Bailie GR, Eisele G (1990) Knowledge of hemodialysis and CAPD patients about their prescribed medicines. Clin Nephrol 34:173–178
Kutner NG, Zhang R, McClellan WM, Cole SA (2002) Psychosocial predictors of non-compliance in haemodialysis and peritoneal dialysis patients. Nephrol Dial Transplant 17:93–99
Morduchowicz G, Sulkes J, Aizic S, Gabbay U, Winkler J, Boner G (1993) Compliance in hemodialysis patients: a multivariate regression analysis. Nephron 64:365–8
Avram MR, Pena C, Burrell D, Antignani A, Avram MM (1990) Hemodialysis and the elderly patient: potential advantages as to quality of life, urea generation, serum creatinine, and less interdialytic weight gain. Am J Kidney Dis 16:342–345
Slatopolsky E, Caglar S, Pennell JP, Taggart DD, Canterbury JM, Reiss E, et al (1971) On the pathogenesis of hyperparathyroidism in chronic experimental renal insufficiency in the dog. J Clin Invest 50:492–499
Giachelli CM (2003) Vascular calcification: in vitro evidence for the role of inorganic phosphate. J Am Soc Nephrol 14 [Suppl 4]:S300–304
Slatopolsky E (2003) New developments in hyperphosphatemia management. J Am Soc Nephrol 14 [Suppl 4]:S297–299
Ganesh SK, Stack AG, Levin NW, Hulbert-Shearon T, Port FK (2001) Association of elevated serum PO(4), Ca x PO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol 12:2131–2138
Block GA, Hulbert-Shearon TE, Levin NW, Port FK (1998) Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis 31:607–617
Utsunomiya M (1996) [Angiographic study of stenosis and calcification of coronary vessels in long-term dialysis patients: examination of risk factors for coronary calcification]. Nippon Jinzo Gakkai Shi 38:155–163
Qunibi WY (2004) Consequences of hyperphosphatemia in patients with end-stage renal disease (ESRD). Kidney Int [Suppl] 90:S8–S12
Foley RN, Parfrey PS, Sarnak MJ (1998) Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 32 [Suppl 3]:S112–119
Kimmel PL, Peterson RA, Weihs KL, Simmens SJ, Alleyne S, Cruz I, et al (1998) Psychosocial factors, behavioral compliance and survival in urban hemodialysis patients. Kidney Int 54:245–254
Wiser NA, Shane JM et al (1997) The effects of a group nutrition education program on nutritional knowledge, nutrition status, and quality of life in hemodialysis patients. J Renal Nutr 7:187–193
Stewart J, Schvaneveldt NB et al (1993) The effect of computerised dietary analysis nutrition education on nutritional knowledge, nutritional status, dietary compliance, and quality of life of hemodialysis patients. J Renal Nutr 4:177–185
Shaw-Stuart NJ, Stuart A (2000) The effect of an educational patient compliance program on serum phosphate levels in patients receiving hemodialysis. J Ren Nutr 10:80–84
Prowant BF, Satalowich RJ, Murray-Bell A, Ryan LP, Schmidt LM, Kennedy JM, et al (1989) Effectiveness of a phosphorous educational program for dialysis patients. Anna J 16:353–357
Schlatter S, Ferrans CE (1998) Teaching program effects on high phosphorus levels in patients receiving hemodialysis. Anna J 25:31–38
Cummings KM, Becker MH, Kirscht JP, Levin NW (1982) Psychosocial factors affecting adherence to medical regiments in a group of hemodialysis patients. Med Care 20:567–580
Hoover H (1989) Compliance in hemodialysis patients: a review of the literature. J Am Diet Assoc 89:957–959
Kapalan de-Nour A, Czackes, JW (1972) Personality factors in chronic hemodialysis patients causing noncompliance with the medical regime. Psychosom Med 34:333–344
Durose CL, Holdsworth M, Watson V, Przygrodzka F (2004) Knowledge of dietary restrictions and the medical consequences of noncompliance by patients on hemodialysis are not predictive of dietary compliance. J Am Diet Assoc 104:35–41
Weed-Collins M, Hogan R (1989) Knowledge and health beliefs regarding phosphate-binding medication in predicting compliance. Anna J 16:278–282, 285–286
Goodman WG, Goldin J, Kuizon BD, Yoon C, Gales B, Sider D, et al (2000) Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 342:1478–1483
Drueke TB, Rostand SG (2002) Progression of vascular calcification in uraemic patients: can it be stopped? Nephrol Dial Transplant 17:1365–1368
Lowrie EG, Lew NL (1990) Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis 15:458–482
Cupisti A, Morelli E, D’Alessandro C, Lupetti S, Barsotti G (2003) Phosphate control in chronic uremia: don’t forget diet. J Nephrol 16:29–33
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Blaszak, R.T., Mitsnefes, M.M., Ilyas, M. et al. Hyperphosphatemia in children receiving peritoneal dialysis—an educational program. Pediatr Nephrol 20, 967–971 (2005). https://doi.org/10.1007/s00467-005-1884-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-005-1884-y