Patient Education and Its Effects on Calcium-Phosphate Balance in Hemodialysis Patients

Calcium-phosphate imbalance is common in hemodialysis patients and is an important cause of increased morbidity and mortality. The objective of this study is to determine the effectiveness of patient education in improving calcium-phosphate balance. This is a cross-sectional cohort study with a control group. Hemodialysis patients at 2 centers with serum phosphate levels ≥ 4.5 mg/dL and a Ca × P product > 55 mg2/dl2 were enrolled into the study. The patients were interviewed to determine their knowledge of phosphate binders, compliance and dietary restrictions. Formal counseling was provided to ensure that the patients were aware of the importance of taking their phosphate binders regularly and the adverse consequences of hyperphosphatemia. At the end of 3 months, the patients’ serum calcium and phosphate levels and CaxP product were measured. In the control arm, no formal counseling was done. 31 patients were enrolled in the study arm and 30 patients were controls. At the start of the study, 39% of patients in the study group were incompliant with their phosphate binders. After counseling, there was a significant decrease in the serum phosphate level (8.6 ± 0.4 vs 7.4 ± 0.6 mg/dl, p < 0.05) and Ca × P product (83.6 ± 4.9 vs 68.9 ± 5.6 mg2/dl2, p < 0.01) of the patients at one month. At 3 months, the mean serum phosphate level and Ca × P product had returned to baseline levels. No significant changes were noted in the control arm. This study suggests that patient education on the use phosphate binders had a positive impact on hyperphosphatemia. However, the effect was lost after one month and continuing patient education may be needed to achieve a long-term result.