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HYPERPHOSPHATEMIA
Elevated phosphorus levels in blood Serum phosphorus > 5.5 mg/dL is associated with 20-40% increase in mortality risk in ESRD patients Involved in development of atherosclerotic heart disease, secondary hyperparathyroidism, and bone disease (renal osteodystrophy)
OBJECTIVE
To determine the effect of limiting the intake of phosphorus-containing food additives on serum phosphorus levels among patients with End-Stage Renal Disease
DESIGN
Cluster randomized controlled trial
ELIGIBILITY CRITERIA
Age 18 years
BASELINE ASSESSMENT
INTERVENTION GROUP
145 participants
First month:
30 minutes nutrition education regarding phosphorus additives/effects Received small magnifier in plastic case Fast-food restaurant handout
Second month:
Telephone intervention
Reinforce instructions/answer questions
CONTROL GROUP
134 participants
First month:
Continued to receive normal care from their facilitys registered dietitians and nephrologists
Second month:
Telephone questionnaire
How often they read nutrition fact labels/ingredient lists, ate meals from fast-food restaurants, received phosphorus-related recommendations from facility dietitian
FOLLOW-UP PROCEDURES
Followed up for 3 months until death/moved Medical records to obtain:
Laboratory test results
OUTCOMES
Secondary outcomes
Effect of intervention by measuring changes in:
Nutritional/food knowledge Reading ingredient lists Reading nutrition fact labels
RESULTS
IG serum phosphorus = 1.0 mg/dL decrease CG serum phosphorus = 0.4 mg/dL decrease
IG > CG by 0.6 mg/dL
Food knowledge score: IG > CG Reads ingredient list: IG > CG Reads nutrition fact labels: IG > CG
Effect of intervention
Difference in Differences (IG) (CG) *IG improvements statistically greater
IMPLICATIONS
Processed diet is a likely contributor to elevated phosphorus levels Phosphorus-containing additives
Almost 100% absorption
Changes in consumption of phosphorus-containing additives linked to changes in serum phosphorus levels More research is
Provide initial nutrition education, periodic counseling and long-term monitoring of patients
APPLICATION TO PRACTICE
Monitor patients lab values/overall health
Provide nutrition education Give patients useful tools/practices that are easy to implement