Overall, educational or behavioral interventions increase adherence to phosphate control. Studies in this systematic review revealed improved outcomes on serum phosphate levels, patient knowledge and adherence to phosphate control methods, CKD self-management behavior and perceived self-efficacy for CKD related to phosphate control. However, there is a lack of sufficient data on how some of the studies implemented their interventions, suggesting that further research is required. Successful strategies that improve and optimize long-term adherence to phosphate control still need to be formulated.
Aim
To evaluate the effectiveness of a bundled self‐management intervention (taking control of your phosphate with the 4Ds) to improve phosphate control among adults receiving haemodialysis.
Background
Hyperphosphataemia occurs in end‐stage kidney disease and is managed by diet, drinks, drugs (phosphate binder medication), and dialysis (the 4Ds). Adherence to the 4Ds is challenging for patients.
Design
A pragmatic cluster randomized controlled trial with repeated measures.
Methods
Participants were adults receiving haemodialysis with high serum phosphate (>1.6 mmol/L for at least 3 months) recruited between August 2017 ‐May 2018. Cluster randomization was according to haemodialysis treatment shifts. The ‘teach‐back’ intervention was designed to improve phosphate control. Expected outcomes were reduced serum phosphate and increased knowledge of phosphate in end‐stage kidney disease, self‐efficacy and adherence to diet, drugs, and dialysis.
Results
There were no differences between groups at baseline. Both groups had similar mean serum phosphate over time; at three months, 46% of the intervention group achieved reductions that met the target serum phosphate level compared with 33% of the control group. There were significant improvements in knowledge of phosphate in end‐stage kidney disease, self‐efficacy and adherence to diet, drugs, and dialysis (missing) in the intervention group compared with control group.
Conclusion
The 4Ds, a bundled self‐management intervention, was effective in improving patient confidence and adherence to phosphate control methods.
Impact
The 4Ds intervention bundles together four essential strategies for preventing and controlling hyperphosphataemia in end‐stage kidney disease.
Trial registration
ACTRN12617000703303 Registered 16/05/2017.
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