Understanding the Associations Between Modifying Factors, Individual Health Beliefs, and Hemodialysis Patients' Adherence to a Low-Phosphorus Diet

Elliott, John O.; Ortman, Carl; Almaani, Salem; Lee, Yun Hui; Jordan, Kim

doi:10.1053/j.jrn.2014.08.006

Cited by 34 publications

(34 citation statements)

References 41 publications

(33 reference statements)

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“…In one study of 95 dialysis patients, White participants were found to self-report greater adherence to a low phosphorus diet, yet were much less likely to have a controlled serum phosphorus level 37 . A post hoc analysis of the Hemodialysis Study found that non-whites were more likely to be prescribed a low phosphorus diet and these patients were also more likely to have lower serum albumin and mildly lower serum phosphorus levels 38 .…”

Section: Discussionmentioning

confidence: 99%

Self-Motivation Is Associated With Phosphorus Control in End-Stage Renal Disease

Umeukeje

Merighi

Browne

et al. 2015

Journal of Renal Nutrition

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Summary Objective Hyperphosphatemia is common in end-stage renal disease (ESRD), and associates with mortality. Phosphate binders reduce serum phosphorus; however, adherence is often poor. This pilot study aims to assess patients’ self-motivation to adhere to phosphate binders, its association with phosphorus control, and potential differences by race. Design Cross-sectional Participants and measurements Subjects were enrolled from one academic medical center dialysis practice from July–November 2012. Self-motivation to adhere to phosphate binders was assessed with the Autonomous Regulation (AR) scale (range: 1–7), and self-reported medication adherence with the Morisky Medication Adherence Scale (MMAS). Linear regression models adjusting for age, gender, health literacy and medication adherence were applied to determine associations with serum phosphorus level, including any evidence of interaction by race. Results Among 100 participants, mean age was 51 years (± 15), 53% were male, 72% were non-white, 89% received hemodialysis, and mean serum phosphorus level was 5.7 [±1.6] mg/dL. More than half (57%) reported the maximum AR score (7). Higher AR scores were noted in those reporting better health overall (p=0.001) and those with higher health literacy (p=0.01). AR score correlated with better medication adherence (r=0.22; p=0.02), and medication adherence was negatively associated with serum phosphorus (r= −0.40; p<0.001). In sub-group analysis among non-whites, higher AR scores correlated with lower serum phosphorus (High vs. Lower AR Score: 5.55 (1.5) vs. 6.96 (2.2); p=0.01). Associations between AR score (β 95% CI: −0.37 (−0.73 – −0.01); p=0.04), medication adherence (β 95% CI: −0.25 (−0.42 – −0.07); p=0.01) and serum phosphorus, persisted in adjusted analyses. Conclusions Self-motivation was associated with phosphate binder adherence and phosphorus control, and this differed by race. Additional research is needed to determine if personalized, culturally sensitive strategies to understand and overcome motivational barriers may optimize mineral bone health in ESRD.

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Section: Discussionmentioning

confidence: 99%

Self-Motivation Is Associated With Phosphorus Control in End-Stage Renal Disease

Umeukeje

Merighi

Browne

et al. 2015

Journal of Renal Nutrition

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“…Compliance with a low-phosphate diet is suggested to be related to different variables including quality of life, education background, self-efficacy, etc. [22] To improve patient adherence in the current study, we invited their family members to participate in the study and to support changes of diet and cooking habits. Our patients showed satisfactory dietary compliance, as all participators have responded to at least one of the dietary intervention components and dietary phosphate intake decreased constantly following 3 months of intervention.…”

Section: Discussionmentioning

confidence: 99%

Improving diet recipe and cooking methods attenuates hyperphosphatemia in patients undergoing peritoneal dialysis

Jiang¹,

Fang²,

Gu³

et al. 2015

Nutrition, Metabolism and Cardiovascular Diseases

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“…It has also been estimated that adherence to binder use as prescribed may be less than 50%. [44][45][46][47][48][49] Recent research has shown that phosphorus absorption varies among foods. Current nutrition advice in phosphate control is moving toward a greater understanding by both patients and health care teams on newly understood mechanisms of phosphate content and absorption.…”

Section: Phosphorus Binders and Food Absorption Differencesmentioning

confidence: 99%

“…Individualized education is needed to help balance portions of commonly available foods. 7,45 Special attention needs to be given to cultural foods since the potassium content may be hard to determine.…”

Section: -56mentioning

confidence: 99%

Strategies to promote adherence to nutritional advice in patients with chronic kidney disease: a narrative review and commentary

Beto¹,

Schury²,

Bansal³

2016

IJNRD

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Chronic kidney disease (CKD) requires extensive changes to food and lifestyle. Poor adherence to diet, medications, and treatments has been estimated to vary between 20% and 70%, which in turn can contribute to increased mortality and morbidity. Delivering effective nutritional advice in patients with CKD coordinates multiple diet components including calories, protein, sodium, potassium, calcium, phosphorus, and fluid. Dietary intake studies have shown difficulty in adhering to the scope and complexity of the CKD diet parameters. No single educational or clinical strategy has been shown to be consistently effective across CKD populations. Highest adherence has been observed when both diet and education efforts are individualized to each patient and adapted over time to changing lifestyle and CKD variables. This narrative review and commentary summarizes nutrition education literature and published strategies for providing nutritional advice in CKD. A cohort of practical and effective strategies for increasing dietary adherence to nutritional advice are provided that include communicating with "talking control" principles, integrating patient-owned technology, acknowledging the typical food pattern may be snacking rather than formal meals, focusing on a single goal rather than multiple goals, creating active learning and coping strategies (frozen sandwiches, visual hands-on activities, planting herb gardens), and involving the total patient food environment.

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Understanding the Associations Between Modifying Factors, Individual Health Beliefs, and Hemodialysis Patients' Adherence to a Low-Phosphorus Diet

Cited by 34 publications

References 41 publications

Self-Motivation Is Associated With Phosphorus Control in End-Stage Renal Disease

Self-Motivation Is Associated With Phosphorus Control in End-Stage Renal Disease

Improving diet recipe and cooking methods attenuates hyperphosphatemia in patients undergoing peritoneal dialysis

Strategies to promote adherence to nutritional advice in patients with chronic kidney disease: a narrative review and commentary

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