Knowledge of Phosphorus Compared with Other Nutrients in Maintenance Dialysis Patients

Overview

Journal J Ren Nutr

Specialties Nephrology
Nutritional Sciences

Date 2007 Aug 28

PMID 17720101

Citations 16

Authors

Judson B Pollock

Jonathan B Jaffery

Affiliations

Soon will be listed here.

Abstract

Objective: This study's objective was to assess knowledge of phosphorus compared with other nutrients in patients undergoing maintenance dialysis (MD).

Design: We compared knowledge of phosphorus vs. other nutrients important to the MD diet (potassium, sodium, and protein) in patients undergoing hemodialysis (HD) and peritoneal dialysis (PD). We further measured gender, age, education level, and functional health literacy to assess correlations in patient nutrient knowledge. Nutrient knowledge was measured using a 25-item Chronic Kidney Disease Knowledge Assessment Tool for Nutrition (CKDKAT-N), and functional health literacy was measured using the short form of the Test of Functional Health Literacy in Adults (S-TOFHLA).

Setting And Patients: Patients received maintenance outpatient PD or HD at Wisconsin Dialysis, Inc. (Madison, WI).

Main Outcome Measure: The main outcome measure was knowledge of phosphorus vs. knowledge of potassium, sodium, and protein.

Results: Forty-seven MD patients participated in the study (29 undergoing HD, 18 undergoing PD, 30 males, 17 females, average age of 58.6 (SD, 13.8) years, and average grade level of 1.4 (SD, 2.6) years of post-secondary education). Thirty-five participants had adequate health literacy, 4 had marginal health literacy, and 8 had inadequate health literacy. The CKDKAT-N scores ranged from 6-21 for 25 items, with a mean score of 13 (SD, 2.91). Knowledge of phosphorus compared with knowledge of other nutrients was poor (0.38 vs. 0.72, P = .003). In a comparison of HD vs. PD patient knowledge, both phosphorus (0.37 vs. 0.42, P = .231) and other nutrients (0.69 vs. 0.80, P = .115) were the same.

Conclusion: Despite regular dietary instruction, patients undergoing MD have a poor knowledge of dietary phosphorus content, compared with knowledge of other nutrients important in chronic kidney disease. Interestingly, there was no difference in nutrition knowledge when comparing PD and HD patients, despite differences in education level and health literacy between groups.

Citing Articles

Assessment of Knowledge on Dietary Management of Chronic Kidney Disease Among Patients Undergoing Hemodialysis at a Tertiary Care Hospital in South India: A Cross-Sectional Analytical Study.

Shanmugapriya K, Yuvaraj S, Vishnupriya D, Vinitha K, Vijayanila G, Zamrun Begam T Cureus. 2024; 16(3):e55342.

PMID: 38559520 PMC: 10981922. DOI: 10.7759/cureus.55342.

The role of low health literacy in shared treatment decision-making in patients with kidney failure.

Toapanta N, Salas-Gama K, Pantoja P, Soler M Clin Kidney J. 2023; 16(Suppl 1):i4-i11.

PMID: 37711638 PMC: 10497376. DOI: 10.1093/ckj/sfad061.

Past, Present, and Future of Phosphate Management.

Doshi S, Wish J Kidney Int Rep. 2022; 7(4):688-698.

PMID: 35497793 PMC: 9039476. DOI: 10.1016/j.ekir.2022.01.1055.

The Impact of Phosphorus Management Today on Quality of Life: Patient Perspectives.

Forfang D, Edwards D, Kalantar-Zadeh K Kidney Med. 2022; 4(4):100437.

PMID: 35372822 PMC: 8971307. DOI: 10.1016/j.xkme.2022.100437.

A Mobile App for Triangulating Strategies in Phosphate Education Targeting Patients with Chronic Kidney Disease in Malaysia: Development, Validation, and Patient Acceptance.

Teong L, Khor B, Purba K, Gafor A, Goh B, Bee B Healthcare (Basel). 2022; 10(3).

PMID: 35327013 PMC: 8950478. DOI: 10.3390/healthcare10030535.

References

Ganesh S, Stack A, Levin N, Hulbert-Shearon T, Port F . Association of elevated serum PO(4), Ca x PO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol. 2001; 12(10):2131-2138. DOI: 10.1681/ASN.V12102131. View

Raggi P, Boulay A, Chasan-Taber S, Amin N, Dillon M, Burke S . Cardiac calcification in adult hemodialysis patients. A link between end-stage renal disease and cardiovascular disease?. J Am Coll Cardiol. 2002; 39(4):695-701. DOI: 10.1016/s0735-1097(01)01781-8. View

Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C . Association of health literacy with diabetes outcomes. JAMA. 2002; 288(4):475-82. DOI: 10.1001/jama.288.4.475. View

Baker D, Gazmararian J, Williams M, Scott T, Parker R, Green D . Functional health literacy and the risk of hospital admission among Medicare managed care enrollees. Am J Public Health. 2002; 92(8):1278-83. PMC: 1447230. DOI: 10.2105/ajph.92.8.1278. View

Uribarri J, Calvo M . Hidden sources of phosphorus in the typical American diet: does it matter in nephrology?. Semin Dial. 2003; 16(3):186-8. DOI: 10.1046/j.1525-139x.2003.16037.x. View

Baker D, Williams M, Parker R, Gazmararian J, Nurss J . Development of a brief test to measure functional health literacy. Patient Educ Couns. 2003; 38(1):33-42. DOI: 10.1016/s0738-3991(98)00116-5. View

Gazmararian J, Williams M, Peel J, Baker D . Health literacy and knowledge of chronic disease. Patient Educ Couns. 2003; 51(3):267-75. DOI: 10.1016/s0738-3991(02)00239-2. View

Durose C, Holdsworth M, Watson V, Przygrodzka F . Knowledge of dietary restrictions and the medical consequences of noncompliance by patients on hemodialysis are not predictive of dietary compliance. J Am Diet Assoc. 2004; 104(1):35-41. DOI: 10.1016/j.jada.2003.10.016. View

Ford J, Pope J, Hunt A, Gerald B . The effect of diet education on the laboratory values and knowledge of hemodialysis patients with hyperphosphatemia. J Ren Nutr. 2004; 14(1):36-44. DOI: 10.1053/j.jrn.2003.09.008. View

10.

Qunibi W, Hootkins R, McDowell L, Meyer M, Simon M, Garza R . Treatment of hyperphosphatemia in hemodialysis patients: The Calcium Acetate Renagel Evaluation (CARE Study). Kidney Int. 2004; 65(5):1914-26. DOI: 10.1111/j.1523-1755.2004.00590.x. View

11.

Block G, Klassen P, Lazarus J, Ofsthun N, Lowrie E, Chertow G . Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004; 15(8):2208-18. DOI: 10.1097/01.ASN.0000133041.27682.A2. View

12.

Cupisti A, DAlessandro C, Baldi R, Barsotti G . Dietary habits and counseling focused on phosphate intake in hemodialysis patients with hyperphosphatemia. J Ren Nutr. 2004; 14(4):220-5. View

13.

Williams M, Parker R, Baker D, Parikh N, Pitkin K, Coates W . Inadequate functional health literacy among patients at two public hospitals. JAMA. 1995; 274(21):1677-82. View

14.

Block G, Levin N, Port F . Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis. 1998; 31(4):607-17. DOI: 10.1053/ajkd.1998.v31.pm9531176. View

15.

Schlatter S, Ferrans C . Teaching program effects on high phosphorus levels in patients receiving hemodialysis. ANNA J. 1998; 25(1):31-6; discussion 37-8. View

16.

Baker D, Parker R, Williams M, Clark W . Health literacy and the risk of hospital admission. J Gen Intern Med. 1998; 13(12):791-8. PMC: 1497036. DOI: 10.1046/j.1525-1497.1998.00242.x. View

17.

Gazmararian J, Baker D, Williams M, Parker R, Scott T, Green D . Health literacy among Medicare enrollees in a managed care organization. JAMA. 1999; 281(6):545-51. DOI: 10.1001/jama.281.6.545. View

18.

Nishizawa Y, Jono S, Ishimura E, Shioi A . Hyperphosphatemia and vascular calcification in end-stage renal disease. J Ren Nutr. 2005; 15(1):178-82. DOI: 10.1053/j.jrn.2004.09.027. View

19.

Slinin Y, Foley R, Collins A . Calcium, phosphorus, parathyroid hormone, and cardiovascular disease in hemodialysis patients: the USRDS waves 1, 3, and 4 study. J Am Soc Nephrol. 2005; 16(6):1788-93. DOI: 10.1681/ASN.2004040275. View

20.

Murphy-Gutekunst L . Hidden phosphorus in popular beverages. Nephrol Nurs J. 2005; 32(4):443-5. View