A randomized controlled trial of an educational intervention to improve phosphate levels in hemodialysis patients

Objective: To determine the effect of a dietetic educational intervention on phosphate and calcium levels of hemodialysis patients. Design: Parallel-group randomized controlled trial. Setting: Teaching hospital hemodialysis unit in London, England. Patients: Fifty-six stable adult hemodialysis patients with hyperphosphatemia. Intervention: An educational intervention and one-to-one teaching session given by a renal dietitian, attempting to improve patients' knowledge of phosphate management and their compliance with diet and medication. Outcome Measurement: Patients' serum phosphate, calcium, and calcium X phosphate products in the 3 months after the intervention, compared with those before the intervention. Results were also compared with a control group that had not undergone the intervention. Results: In the intervention group, serum phosphate was significantly reduced after the education session, as compared with the results previously. In the control group, there was no significant change in serum phosphate level. The improved results were sustained over a period of 3 months. Serum calcium increased in the intervention group, but this result was not significant. There was an improvement in the calcium-phosphate product in the intervention group, but again this was not significant. Conclusion: Dietetic educational intervention can favorably alter patients' serum phosphate levels, with potential impact on morbidity and mortality. (C) 2003 by the National Kidney Foundation, Inc.