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Review
, 21 (4), 285-94

Educational Strategies to Reduce Serum Phosphorus in Hyperphosphatemic Patients With Chronic Kidney Disease: Systematic Review With Meta-Analysis

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Review

Educational Strategies to Reduce Serum Phosphorus in Hyperphosphatemic Patients With Chronic Kidney Disease: Systematic Review With Meta-Analysis

Daniel Caldeira et al. J Ren Nutr.

Abstract

Objective: To systematically review educational strategies for phosphorus reduction in patients with hyperphosphatemia and chronic kidney disease (CKD).

Design: Systematic review with meta-analysis.

Data sources: CENTRAL, MEDLINE, EMBASE, and mRCT databases were assessed in June 2010.

Study selection: Randomized controlled trials evaluating educational strategies related to diet in hyperphosphatemic patients with CKD. DATA EXTRACTION AND SYNTHESIS METHOD: Study characteristics, phosphorus levels, and calcium-phosphorus product levels were retrieved. Jadad scale was used for quality assessment. Mean difference (MD) and 95% confidence intervals (CIs) were calculated by random effects method.

Results: Seven randomized controlled trials were retrieved with a total of 524 patients with hyperphosphatemia and CKD. Educational strategies reduced phosphorus levels with an MD of -0.72 mg/dL (95% CI: -1.11 to -0.33, P < .01). Sensitivity analysis of trials with follow-up of <4 months did not show any benefit of the intervention, but educational intervention for ≥ 4 months showed an MD of -1.07 (95% CI: -1.49 to -0.64, P < .01). Calcium-phosphorus product level was improved in 227 evaluated patients from 5 trials with an MD of -5.22 mg(2)/dL(2) (95% CI: -9.48 to -0.98, P = .02, and I(2) = 58%). Sensitivity analysis removed the source of heterogeneity and resulted in an MD of -3.02 (95% CI: -6.51 to 0.47, P = .09).

Conclusions: Education helped reduce phosphorus levels in hyperphosphatemic patients with CKD, particularly those on dialysis.

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