Patient education: an efficient adjuvant therapy for hyperphosphatemia in hemodialysis patients

Hemodialysis and phosphate (P) binder therapy are the major methods to reduce the phosphate level in dialysis patients. However, dietary P restriction is necessary for adequate control. The successful dietary control is based on patient compliance. Patient education is the best method to assure the knowledge and drive of dietary control, which are the key features for patient compliance. The aim of the study is to investigate quantitatively the effect of patient education on serum P levels in hyperphosphatemic hemodialysis patients.

We conducted a prospective self-control study. Fifty hemodialysis patients with a pre-dialysis serum P level greater than 6.0 mg/dL were studied. Intensified patient education was given. Serum P, calcium (Ca), and intact parathyroid hormone (iPTH) were evaluated before and one month after patient education.

Thirty-six (72%) patients had improved pre-dialysis P level (pre-education: 7.50 +/- 1.33; post-education: 5.85 +/- 1.20 mg/dL, p < 0.001) and Ca x P product (pre-education: 68.17 +/- 12.70; post-education: 54.70 +/- 11.87 mg(2)/dL(2), p < 0.001). The effect lasted for at least three months. There is no significant change on calcium levels. The only predictor of a successful patient education is the iPTH level (improved: 348.8 +/- 277.6; non-improved: 668.0 +/- 674.1 ng/mL, p = 0.021).

Patient education could be helpful and efficient in hyperphosphatemic control in dialysis patients. The patient education should be given before the serum iPTH level getting high.