Dietitian-led education program to improve phosphate control in a single-center hemodialysis population

J Ren Nutr. 2009 Jul;19(4):314-20. doi: 10.1053/j.jrn.2008.11.001.


Objective: We sought to analyze the effect of a structured, dietitian-led education program on patients' general knowledge of phosphate and phosphate binders, and its impact on serum phosphate concentrations in a single-center hemodialysis population.

Design: We compared subjects before and after intervention.

Setting: This study involved two dialysis units operated by a single center.

Patients: One hundred and fifteen hemodialysis patients consented to participate in this study (54% male; mean age, 61.1 years; 32% Asian). Patients acted as their own controls. One hundred and eight patients completed the study.

Intervention: All patients completed a questionnaire to assess their knowledge of phosphate and phosphate-binder therapy. Small group teaching sessions were then delivered to patients by a single dietitian, with the aid of a hospital interpreter as required. Patients also received information booklets or audio cassettes translated into Urdu. A second identical questionnaire was completed a month later.

Main outcome measures: Outcome measures involved pre-education and posteducation knowledge scores, monthly measurements of serum phosphate, calcium, and mean Kt/V, and parathyroid hormone concentrations every 3 months during the 5 month run-in period and subsequent 5-month study period.

Results: The education program significantly improved patients' general knowledge of phosphate and of phosphate-binders (P < .001), especially in patients with a low pretest score and those of South Asian origin. This result was associated with a significant reduction in serum phosphate in patients with hyperphosphatemia (P = .032).

Conclusions: These findings suggest that a combination of educational initiatives is effective in enhancing patients' knowledge of phosphate and phosphate-binders, and consequently in improving serum phosphate levels in patients with hyperphosphatemia.

MeSH terms

  • Chelating Agents / therapeutic use
  • Diet
  • Dietetics*
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Hyperphosphatemia / etiology
  • Hyperphosphatemia / prevention & control*
  • Hyperphosphatemia / therapy
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • Patient Education as Topic*
  • Phosphates / blood
  • Renal Dialysis*
  • Surveys and Questionnaires


  • Chelating Agents
  • Phosphates