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Yokum, Dawn (2009) Evaluation of phosphate knowledge and the effectiveness of a phosphate management protocol to achieve optimum serum phosphate levels in haemodialysis patients. Masters thesis, London Metropolitan University.
Despite current medical and dietetic treatments designed to achieve and maintain acceptable serum phosphate levels, current prevalence rates of hyperphosphataemia and associated health risks, in haemodialysis patients indicate that controlling serum phosphate levels remains a challenge in the 21st century.
The aims of this study were to evaluate ( 1 ) the effectiveness of a phosphate management protocol designed to optimise serum phosphate levels in patients undergoing regular haemodialysis and (2) changes in phosphate knowledge scores as a result of phosphate education by a renal research pharmacist and renal dietitian.
A randomised, controlled trial was carried out at haemodialysis units at Barts and the London NHS Trusts and satellite units. The project followed thirty-four clinically stable adults undergoing regular haemodialysis with a serum phosphate level > 1.8mmol/l on at least one occasion within 4 months of starting the study.
Intervention entailed management of serum phosphate levels using a specially designed protocol during a 4 month study period implemented by a renal dietitian and renal pharmacist, in contrast with standard practice. The protocol group for this study received phosphate education from the renal pharmacists and renal dietitians, as part of the protocol procedure, whereas the control group received instruction from a renal doctor and another renal dietitian. Changes in serum phosphate levels were monitored over period of 4 months in both groups. Before and 4 months after the study, patients’ phosphate knowledge was also tested in both groups using a phosphate knowledge questionnaire specially designed for this study.
The results showed that on comparing the phosphate management protocol group and patients receiving standard practice a significant difference in the mean change in serum phosphate levels was achieved (-0.22 ± 0.67mmol/l, t= -1.23 vs +0.19 ± 0.32mmol/l, t= +2.46, P = 0.03).
However, there were no detectable differences in patients’ knowledge about complications of hyperphosphataemia pre and post intervention in either group, indicating a need to address this issue.
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