Results of a Pilot Program to Improve Phosphorus Outcomes in Hemodialysis Patients

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• 作者：Tracy J. Mayne ; Debbie Benner ; Kathy Ricketts ; Mary Burgess ; Steve Wilson ; Lynne Poole ; Michael Smyth ; Carey Colson ; Mahesh Krishnan
• 刊名：Journal of Renal Nutrition
• 出版年：2012
• 出版时间：September, 2012
• 年：2012
• 卷：22
• 期：5
• 页码：472-479
• 全文大小：122 K

文摘

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Objective

End-stage renal disease causes dysregulation of bone and mineral metabolism, including increased serum phosphorus levels. Kidney Foundation Kidney Disease Outcome Quality Initiative 2003 guidelines recommend maintaining phosphorus levels between 3.5 and 5.5 mg/dL in dialysis patients. We examined the effects of a?focused phosphorus management pilot program designed to improve the percentage of hemodialysis patients achieving phosphorus levels <5.5 mg/dL.

Design, Setting, Subjects, and Intervention

We conducted a prospective, multicenter, single-arm study at 8?geographically diverse at-risk facilities (n = 702 hemodialysis patients) in a large U.S. dialysis organization. The focused phosphorus management program provided in-service training to staff members, and provided patients with diet and phosphorus management through in-center, 1:1 education and support, direct-to-patient adherence communications, benefit management assistance, and adherence support specific to lanthanum carbonate over a 6-month period.

Main Outcome Measure

Facility-level markers of bone and mineral metabolism (phosphorus, parathyroid hormone, corrected calcium) and nutritional status (serum albumin, normalized protein catabolic rate) were assessed before and after program implementation.

Results

There was a significant increase in the percentage of patients per facility achieving phosphorus levels <5.5 mg/dL (mean ¡À SD at baseline = 61.6 % ¡À 5.2 % ; month 6 = 71.3 % ¡À 9.0 % ; P < .01) and parathyroid hormone (150 to 300 pg/mL; mean ¡À SD at baseline = 39.1 % ¡À 2.4 % ; month 6 = 44.5 % ¡À 7.0 % ; P = .04). During the course of the evaluation, mean calcium, albumin, and normalized protein catabolic rate levels did not change significantly.

Conclusions

These results show proof-of-concept that a focused phosphorus management program targeting both staff members and patients can significantly improve patient outcomes without compromising nutritional status.