Phosphorus nutritional knowledge among dialysis health care providers and patients: A multicenter observational study

Abstract

Background-Aims: Phosphorus nutritional knowledge level of hemodialysis patients and renal nurses has been found to be low, while respective knowledge of nephrologists has not been studied yet. There are equivocal results regarding the association of phosphorus nutritional knowledge level and serum phosphorus values. The aim of this study was to assess phosphorus nutritional knowledge of hemodialysis patients, nephrologists and renal nurses and seek potential interventions to improve patients' adherence to phosphorus and overall nutritional guidelines. Methods: This cross-sectional observational study was conducted on sixty eight hemodialysis patients, 19 renal nurses and 11 nephrologists who were recruited from 3 hemodialysis units in Greece. Phosphorus nutritional knowledge of the participants was assessed by a 25-item item questionnaire (CKDKAT-N) which included 15 questions on phosphorus and 10 questions on protein, sodium, and potassium knowledge. Results: Nephrologists had higher CKDKAT-N total (19.1 ± 3.6 vs 14.1 ± 2.8 and 13.2± 2.8, P<0.01) and phosphorus knowledge scores (10.6 ± 2.7 vs 7.6 ± 2.2 and 7.3 ± 2.0, P<0.01) compared to renal nurses and patients respectively. There were no differences in total and phosphorus knowledge scores between nurses and patients. Patients and nurses answered correctly significantly less questions regarding phosphorus compared with the rest of the questions (P<0.01) while no such difference was found in nephrologists. Serum phosphorus was positively correlated with phosphorus knowledge score (r=0.31, P=0.02), and negatively correlated with patient age (r=−0.34, P<0.

Poor Sleep Quality, Depression and Social Support Are Determinants of Serum Phosphate Level among Hemodialysis Patients in Malaysia

“…Theoretically, patients with better knowledge possess higher awareness and are able to make better choices compared to lower knowledge patients. Several studies also have highlighted the lack of knowledge as a contributory factor to poor phosphate control, despite the association between phosphorus nutrition knowledge and serum phosphorus level being equivocal [ 65 ]. Similar to our findings, previous studies have reported better knowledge does not always translate to a better serum phosphate level [ 11 , 22 , 65 , 66 , 67 ].…”

“…Several studies also have highlighted the lack of knowledge as a contributory factor to poor phosphate control, despite the association between phosphorus nutrition knowledge and serum phosphorus level being equivocal [ 65 ]. Similar to our findings, previous studies have reported better knowledge does not always translate to a better serum phosphate level [ 11 , 22 , 65 , 66 , 67 ]. With the growing body of evidence that educating hemodialysis patients on phosphorus improved serum phosphate levels [ 68 , 69 , 70 , 71 ], it is incumbent upon the healthcare professional community to acknowledge that education programs are indispensable for the optimal management of hemodialysis patients in routine care [ 72 ].…”

Understanding How Nutrition Literacy Links to Dietary Adherence in Patients Undergoing Maintenance Hemodialysis: A Theoretical Exploration using Partial Least Squares Structural Equation Modeling

“…Lack of dietetic services in the HD setting is a critical problem reported in Malaysia and other Asian countries [ 76 , 77 ]. As such, nephrologists and nurses have become the primary sources of dietary information for HD patients [ 76 , 78 ]. However, due to time constraints [ 79 ], nutrition education might not always be their priority.…”

“…For instance, the majority of the patients (44.5%) in this study claimed that diet counselling from health professionals was rarely provided. In addition, the quality of patient nutrition education is also likely to be undermined by nutrition knowledge incompetency among healthcare professionals [ 78 ]. Therefore, the provision of dietitians in dialysis centres remains advocated for successful nutrition management [ 80 ].…”

Medical Nutrition Therapy Access in CKD: A Cross-sectional Survey of Patients and Providers

“…10 Also, despite existing evidence-based practice guidelines 11,12 , providers may be unaware or unconvinced of medical nutrition therapy as a tool to reduce CKD progression. 13,14 Logistical challenges, such as availability of practitioners, transportation, and time are other common barriers that reduce patient access to registered dietitian nutritionists with expertise in kidney disease, known as renal registered dietitian nutritionists. 15,16 Although limited research exists regarding access to CKD nutrition care, studies on access to diabetes self-management training have noted that patients who are most vulnerable, including non-whites, older individuals, those with comorbidities, and the newly diagnosed, were least likely to access care.…”