Phosphate-control adherence in hemodialysis patients: current perspectives
Ebele M Umeukeje,1–3 Amanda S Mixon,3,4 Kerri L Cavanaugh1–3 1Vanderbilt Center for Kidney Disease, Nashville, TN, USA; 2Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville TN, USA; 3Vanderbilt Center for Health Services Research, Nash...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2018-07-01
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| Series: | Patient Preference and Adherence |
| Subjects: | |
| Online Access: | https://www.dovepress.com/phosphate-control-adherence-in-hemodialysis-patients-current-perspecti-peer-reviewed-article-PPA |
| _version_ | 1811327251609812992 |
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| author | Umeukeje EM Mixon AS Cavanaugh KL |
| author_facet | Umeukeje EM Mixon AS Cavanaugh KL |
| author_sort | Umeukeje EM |
| collection | DOAJ |
| description | Ebele M Umeukeje,1–3 Amanda S Mixon,3,4 Kerri L Cavanaugh1–3 1Vanderbilt Center for Kidney Disease, Nashville, TN, USA; 2Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville TN, USA; 3Vanderbilt Center for Health Services Research, Nashville, TN, USA; 4Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, TN, USA Objectives: This review summarizes factors relevant for adherence to phosphate-control strategies in dialysis patients, and discusses interventions to overcome related challenges. Methods: A literature search including the terms “phosphorus”, “phosphorus control”, “hemodialysis”, “phosphate binder medications”, “phosphorus diet”, “adherence”, and “nonadherence” was undertaken using PubMed, PsycInfo, CINAHL, and Embase. Results: Hyperphosphatemia is associated with cardiovascular and all-cause mortality in dialysis patients. Management of hyperphosphatemia depends on phosphate binder medication therapy, a low-phosphorus diet, and dialysis. Phosphate binder therapy is associated with a survival benefit. Dietary restriction is complex because of the need to maintain adequate protein intake and, alone, is insufficient for phosphorus control. Similarly, conventional hemodialysis alone is insufficient for phosphorus control due to the kinetics of dialytic phosphorus removal. Thus, all three treatment approaches are important contributors, with dietary restriction and dialysis as adjuncts to the requisite phosphate binder therapy. Phosphate-control adherence rates are suboptimal and are influenced directly by patient, provider, and phosphorus-control strategy-related factors. Psychosocial factors have been implicated as influential “drivers” of adherence behaviors in dialysis patients, and factors based on self-motivation associate directly with adherence behavior. Higher-risk subgroups of nonadherent patients include younger dialysis patients and non-whites. Provider attitudes may be important – yet unaddressed – determinants of adherence behaviors of dialysis patients. Conclusion: Adherence to phosphate binders, low-phosphorus diet, and dialysis prescription is suboptimal. Multicomponent strategies that concurrently address therapy-related factors such as side effects, patient factors targeting self-motivation, and provider factors to improve attitudes and delivery of culturally sensitive care show the most promise for long-term control of phosphorus levels. Moreover, it will be important to identify patients at highest risk for lack of control, and for programs to be ready to deliver flexible person-centered strategies through training and dedicated resources to align with the needs of all patients. Keywords: hyperphosphatemia, adherence, phosphorus binders, low-phosphorus diet, dialysis |
| first_indexed | 2024-04-13T15:03:19Z |
| format | Article |
| id | doaj.art-719bd4a9d01d48859b1ddacc26a7ea3c |
| institution | Directory Open Access Journal |
| issn | 1177-889X |
| language | English |
| last_indexed | 2024-04-13T15:03:19Z |
| publishDate | 2018-07-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Patient Preference and Adherence |
| spelling | doaj.art-719bd4a9d01d48859b1ddacc26a7ea3c2022-12-22T02:42:14ZengDove Medical PressPatient Preference and Adherence1177-889X2018-07-01Volume 121175119139173Phosphate-control adherence in hemodialysis patients: current perspectivesUmeukeje EMMixon ASCavanaugh KLEbele M Umeukeje,1–3 Amanda S Mixon,3,4 Kerri L Cavanaugh1–3 1Vanderbilt Center for Kidney Disease, Nashville, TN, USA; 2Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville TN, USA; 3Vanderbilt Center for Health Services Research, Nashville, TN, USA; 4Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, TN, USA Objectives: This review summarizes factors relevant for adherence to phosphate-control strategies in dialysis patients, and discusses interventions to overcome related challenges. Methods: A literature search including the terms “phosphorus”, “phosphorus control”, “hemodialysis”, “phosphate binder medications”, “phosphorus diet”, “adherence”, and “nonadherence” was undertaken using PubMed, PsycInfo, CINAHL, and Embase. Results: Hyperphosphatemia is associated with cardiovascular and all-cause mortality in dialysis patients. Management of hyperphosphatemia depends on phosphate binder medication therapy, a low-phosphorus diet, and dialysis. Phosphate binder therapy is associated with a survival benefit. Dietary restriction is complex because of the need to maintain adequate protein intake and, alone, is insufficient for phosphorus control. Similarly, conventional hemodialysis alone is insufficient for phosphorus control due to the kinetics of dialytic phosphorus removal. Thus, all three treatment approaches are important contributors, with dietary restriction and dialysis as adjuncts to the requisite phosphate binder therapy. Phosphate-control adherence rates are suboptimal and are influenced directly by patient, provider, and phosphorus-control strategy-related factors. Psychosocial factors have been implicated as influential “drivers” of adherence behaviors in dialysis patients, and factors based on self-motivation associate directly with adherence behavior. Higher-risk subgroups of nonadherent patients include younger dialysis patients and non-whites. Provider attitudes may be important – yet unaddressed – determinants of adherence behaviors of dialysis patients. Conclusion: Adherence to phosphate binders, low-phosphorus diet, and dialysis prescription is suboptimal. Multicomponent strategies that concurrently address therapy-related factors such as side effects, patient factors targeting self-motivation, and provider factors to improve attitudes and delivery of culturally sensitive care show the most promise for long-term control of phosphorus levels. Moreover, it will be important to identify patients at highest risk for lack of control, and for programs to be ready to deliver flexible person-centered strategies through training and dedicated resources to align with the needs of all patients. Keywords: hyperphosphatemia, adherence, phosphorus binders, low-phosphorus diet, dialysishttps://www.dovepress.com/phosphate-control-adherence-in-hemodialysis-patients-current-perspecti-peer-reviewed-article-PPAhyperphosphatemiaadherencephosphorus binderslow phosphorus dietdialysis |
| spellingShingle | Umeukeje EM Mixon AS Cavanaugh KL Phosphate-control adherence in hemodialysis patients: current perspectives Patient Preference and Adherence hyperphosphatemia adherence phosphorus binders low phosphorus diet dialysis |
| title | Phosphate-control adherence in hemodialysis patients: current perspectives |
| title_full | Phosphate-control adherence in hemodialysis patients: current perspectives |
| title_fullStr | Phosphate-control adherence in hemodialysis patients: current perspectives |
| title_full_unstemmed | Phosphate-control adherence in hemodialysis patients: current perspectives |
| title_short | Phosphate-control adherence in hemodialysis patients: current perspectives |
| title_sort | phosphate control adherence in hemodialysis patients current perspectives |
| topic | hyperphosphatemia adherence phosphorus binders low phosphorus diet dialysis |
| url | https://www.dovepress.com/phosphate-control-adherence-in-hemodialysis-patients-current-perspecti-peer-reviewed-article-PPA |
| work_keys_str_mv | AT umeukejeem phosphatecontroladherenceinhemodialysispatientscurrentperspectives AT mixonas phosphatecontroladherenceinhemodialysispatientscurrentperspectives AT cavanaughkl phosphatecontroladherenceinhemodialysispatientscurrentperspectives |