Effectiveness of educational or behavioral interventions on adherence to phosphate control in adults receiving hemodialysis: a systematic review

Abstract

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.

Decreasing hospitalizations in patients on hemodialysis: Time for a paradigm shift

“…It is also important to recognize that dialysis facility education focuses on isolated patient behaviors such as IDWG and dietary phosphorus intake, both of which are metrics followed up for reimbursement . Education about the contribution of vascular access type and function, dietary and dialysis nonadherence, uremia, malnutrition, and infection risk is not systematically undertaken by facility staff . Patients do not universally recognize or attribute the symptoms of uremia or IDWG to dialysis parameters or self‐management behaviors .…”

A bundled phosphate control intervention (4Ds) for adults with end‐stage kidney disease receiving haemodialysis: A cluster randomized controlled trial protocol

“…The sessions promote the development of progressive achievement (performance accomplishment) and independence through verbal persuasion as feedback is immediate. The format of the sessions was informed by a systematic review (Milazi et al., ) which found that education given over at least 12 weeks and is repeated/reinforced with intensive follow‐up is likely to lead to sustained improvement in phosphate levels and other patient‐reported outcomes (knowledge, self‐efficacy and adherence).…”

“…Sample size estimation uses the recent meta‐analysis (Milazi et al., ) of serum phosphate level as a physiological index of adherence to phosphate control methods. To achieve 80% power, an alpha of 5% (two‐tailed) and an estimated standardized mean difference between groups of 0.5 (SD 0.39 mmol/L), a sample size of 21 participants per group is needed.…”

“…Effective phosphate control strategies are complex and multifaceted. A recent systematic review examined the effectiveness of educational or behavioural interventions on adherence to phosphate control in adults receiving HD (Milazi, Bonner, & Douglas, ). The review included 18 studies of which eight were randomized control trials (RCTs): seven studies focused on dietary phosphate, four studies focused on medications (phosphate binders) and six studies focused on dietary phosphate and medications.…”

“…Sixteen studies showed significant improvements in phosphate levels. A meta‐analysis of the RCTs favoured educational or behavioural interventions over standard care for serum phosphate control (Milazi et al., ). These authors concluded that educational or behavioural interventions are likely to improve phosphate control among adults with ESKD and that further studies targeting all four methods of phosphate control are required (Milazi et al., ).…”