A bundled phosphate control intervention (4Ds) for adults with end‐stage kidney disease receiving haemodialysis: A cluster randomized controlled trial. (4th December 2020)

• Record Type: Journal Article
• Authors: Milazi, Molly; Douglas, Clint; Bonner, Ann
• Is Part Of: Journal of advanced nursing. Volume 77:Number 3(2021)
• Page Start: 1345
• Page End: 1356
• Publication Date: 2020-12-04
• Subjects: adherence -- end‐stage kidney disease -- haemodialysis -- knowledge -- nursing -- phosphate -- self‐management; Nursing -- Periodicals; 610.7305
• DOI: 10.1111/jan.14700
• Languages: English
• ISSNs: 0309-2402

Abstract

Abstract: Aim: To evaluate the effectiveness of a bundled self‐management intervention (taking control of your phosphate with the 4Ds) to improve phosphate control among adults receiving haemodialysis. Background: Hyperphosphataemia occurs in end‐stage kidney disease and is managed by diet, drinks, drugs (phosphate binder medication), and dialysis (the 4Ds). Adherence to the 4Ds is challenging for patients. Design: A pragmatic cluster randomized controlled trial with repeated measures. Methods: Participants were adults receiving haemodialysis with high serum phosphate (>1.6 mmol/L for at least 3 months) recruited between August 2017 ‐May 2018. Cluster randomization was according to haemodialysis treatment shifts. The 'teach‐back' intervention was designed to improve phosphate control. Expected outcomes were reduced serum phosphate and increased knowledge of phosphate in end‐stage kidney disease, self‐efficacy and adherence to diet, drugs, and dialysis. Results: There were no differences between groups at baseline. Both groups had similar mean serum phosphate over time; at three months, 46% of the intervention group achieved reductions that met the target serum phosphate level compared with 33% of the control group. There were significant improvements in knowledge of phosphate in end‐stage kidney disease, self‐efficacy and adherence to diet, drugs, and dialysis (missing) in the intervention group compared with control group. Conclusion: The 4Ds, a bundled self‐management intervention, was effective in improving patient confidence and adherence to phosphate control methods. Impact: The 4Ds intervention bundles together four essential strategies for preventing and controlling hyperphosphataemia in end‐stage kidney disease. Trial registration: ACTRN12617000703303 Registered 16/05/2017. 摘要: 目的: 评估捆绑式自我管理干预 (用4Ds控制磷酸盐) 在接受血液透析的成人中改善磷酸盐控制的有效性。 背景: 高磷血症发生于终末期肾脏疾病, 通过饮食、饮料、药物 (磷酸盐结合剂药物) 和透析(4Ds)来处理。坚持4Ds对患者来说是具有挑战性的。 设计: 重复测量实用集群随机对照试验。 方法: 参与者为2017年8月至2018年5月期间招募的接受高血清磷酸盐 (至少3个月>1.6mmol/L) 血液透析的成人。根据血液透析治疗班次进行集群随机分组。"临床教学"干预旨在改善磷酸盐控制。预期结果是降低血清磷酸盐, 增加终末期肾病患者对磷酸盐的了解、自我效能感和对饮食、药物和透析的依从性。 结果: 基准组间无差异。随着时间的推移, 两组的平均血清磷酸盐水平相似; 三个月时, 46%的干预组血清磷酸盐水平降低, 而对照组这一值为33%。域对照组相比, 干预组对终末期肾病患者的磷酸盐知识、自我效能感以及对饮食、药物和透析 (缺失) 的依从性均有显著提高。 结论: 饮食、饮料、药物 (磷酸盐结合剂药物) 和透析(4Ds)是一种捆绑式的自我管理干预措施, 在提高患者对磷酸盐控制方法的信心和依从性方面是有效的。 影响: 饮食、饮料、药物 (磷酸盐结合剂药物) 和透析(4Ds)干预结合了预防和控制终末期肾病高磷血症的四种基本策略。 试验注册: ACTRN12617000703303 注册日期: 2017年5月16日