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Rhee CM, Zhou M, Woznick R, Mullon C, Anger MS, Ficociello LH. A real-world analysis of the influence of age on maintenance hemodialysis patients: managing serum phosphorus with sucroferric oxyhydroxide as part of routine clinical care. Int Urol Nephrol 2023; 55:377-387. [PMID: 35953565 PMCID: PMC9859895 DOI: 10.1007/s11255-022-03327-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/25/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Despite the growing number of elderly hemodialysis patients, the influence of age on nutritional parameters, serum phosphorus (sP), and use of phosphate-binder (PB) medications has not been well characterized. We aimed to describe age-related differences in patient characteristics in a large, real-world cohort of maintenance hemodialysis patients, and to examine the impact of age on sP management with sucroferric oxyhydroxide (SO). METHODS We retrospectively analyzed de-identified data from 2017 adult, in-center hemodialysis patients who switched from another PB to SO monotherapy as part of routine clinical care. Changes in baseline PB pill burden, sP levels, and nutritional and dialytic clearance parameters were assessed across varying age groups through 6 months. RESULTS At baseline, older patients had lower mean sP, serum albumin, and pre-dialysis weights compared with younger patients. Prescription of SO was associated with a 62% increase in the proportion of patients achieving sP ≤ 5.5 mg/dl and a 42% reduction in daily pill burden. The proportion of patients achieving sP ≤ 5.5 mg/dl after transitioning to SO increased by 113, 96, 68, 77, 61, 37 and 40% among those aged 19-29, 30-39, 40-49, 50-59, 60-69, 70-79, and ≥ 80 years, respectively. CONCLUSIONS Older patients had worse nutritional parameters, lower pill burden, and lower sP at baseline versus younger counterparts. Prescription of SO was associated with improved sP control and reduced pill burden across all ages.
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Affiliation(s)
- Connie M. Rhee
- grid.266093.80000 0001 0668 7243Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, CA USA
| | - Meijiao Zhou
- grid.419076.d0000 0004 0603 5159Global Medical Office, Fresenius Medical Care, 920 Winter Street, Waltham, MA 02451 USA
| | | | - Claudy Mullon
- grid.419076.d0000 0004 0603 5159Global Medical Office, Fresenius Medical Care, 920 Winter Street, Waltham, MA 02451 USA
| | - Michael S. Anger
- grid.419076.d0000 0004 0603 5159Global Medical Office, Fresenius Medical Care, 920 Winter Street, Waltham, MA 02451 USA
| | - Linda H. Ficociello
- grid.419076.d0000 0004 0603 5159Global Medical Office, Fresenius Medical Care, 920 Winter Street, Waltham, MA 02451 USA
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Alzahrani AMA, Al-Khattabi GH. Factors Affecting Adherence to Phosphate-binding Medications among Patients with End-stage Kidney Disease in Makkah City. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:516-525. [PMID: 37929544 DOI: 10.4103/1319-2442.388186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Despite the evidence that the management of hyperphosphatemia depends heavily on adherence to phosphate-binding (PB) medications, many dialysis patients are non-adherent. Therefore, factors associated with non-adherence to PB medications should be identified and eliminated. This study aimed to identify and highlight factors influencing adherence to PB medications among patients with end-stage kidney disease (ESKD). A cross-sectional survey was conducted in the hemodialysis centers of three major governmental hospitals in Makkah City, Saudi Arabia. The World Health Organization's five dimensions of adherence to medication (patient, socioeconomic, condition, therapy, and health system) were used to guide the analysis. A multivariable logistic regression analysis was used to determine factors influencing adherence to PB medications among patients with ESKD. Three hundred and fifty-eight patients submitted completed questionnaires and were included in this study; of them, 87.99% were adherent to PB medications. The factors sex, adherence to dietary restrictions, and duration on dialysis were found to be significantly and positively associated with adherence to PB medications, whereas the factors difficulty to take medications and difficulty to adhere to a large number of tablets had significant and negative associations with adherence to PB medications. Hyperphosphatemia is a cause for concern as it leads to several life-threatening complications. The results of the present study encourage to recruit representative samples and consider more factors, such as patients' attitudes toward medications and provider-level factors, to inform policy and/or programmatic interventions that increase adherence to PB medications among patients with ESKD.
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Affiliation(s)
- Ali Mohammed A Alzahrani
- Department of Health Services Management, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ghanim H Al-Khattabi
- Department of Preventive Medicine and Public Health Executive, Ministry of Health, Makkah, Saudi Arabia
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Gasu V, Ashong M, Seferi A, Fitzpatrick A. Effectiveness of phosphate binders in adult patients with end stage renal disease receiving hemodialysis: a systematic review. ACTA ACUST UNITED AC 2020; 17:49-73. [PMID: 30204711 DOI: 10.11124/jbisrir-2017-003740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The objective of the review was to evaluate the effectiveness of the use of phosphate binders on mortality and serum levels of phosphorus, calcium and parathyroid hormone in adult patients with end stage renal disease receiving hemodialysis compared to hemodialysis with no phosphate binder use. INTRODUCTION End stage renal disease leading to hemodialysis is a common global health issue. Effective management of this population is focused on balancing alterations in bone mineral markers such as phosphorus, calcium and parathyroid hormone. Chronic imbalances are associated with all-cause mortality. Phosphate binders are a crucial element to regulating these levels. INCLUSION CRITERIA The review considered studies including adult patients, age 18 and over, receiving hemodialysis. The intervention of interest was the use of any drug within the class of phosphate binders. Outcomes of interest were all-cause mortality and serum levels of phosphorus, calcium and parathyroid hormone. Experimental and quasi-experimental study designs were considered. METHODS A search for relevant published and unpublished literature was conducted through November 5, 2017. Databases searched included PubMed, CINAHL, Embase and Cochrane Central Register of Controlled Trials (CENTRAL), in addition to gray literature sources. Articles that met the inclusion criteria were further assessed for methodological validity by two independent reviewers using the standard critical appraisal instruments from Joanna Briggs Institute. Data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute. Quantitative data were pooled for statistical meta-analysis to evaluate the impact of phosphate binders on phosphorus and calcium. RESULTS Seven studies were included in this review. A meta-analysis of four studies showed that the use of phosphate binders resulted in a statistically significant decrease in phosphorus levels compared to placebo (mean difference -1.89 mg/dL, 95% confidence interval -2.03 mg/dL, -1.75 mg/dL); three additional studies described narratively also showed a statistically significant decrease in phosphorus. A meta-analysis of three studies showed a statistically significant increase in calcium compared to placebo (mean difference 0.57 mg/dL, 95% confidence interval 0.50 mg/dL, 0.64 mg/dL); two additional studies described narratively showed no difference in effect on calcium. Of the three studies that measured parathyroid hormone, one showed a statistically significant improvement with the use of phosphate binders (mean difference -83.0 pg/mL, 95% confidence interval -154.63 pg/mL, -11.37 pg/mL) and two showed no difference in effect. No studies measured mortality. CONCLUSION Phosphate binders are effective in reducing serum phosphorus. The findings on parathyroid hormone and calcium did not provide adequate support for phosphate binder use. The impact on mortality was not directly measured in any of the included studies.
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Affiliation(s)
- Vivian Gasu
- College of Health Professions, Pace University, New York, USA.,The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Center of Excellence
| | - Mary Ashong
- College of Health Professions, Pace University, New York, USA.,The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Center of Excellence
| | - Arta Seferi
- College of Health Professions, Pace University, New York, USA.,The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Center of Excellence
| | - Aileen Fitzpatrick
- College of Health Professions, Pace University, New York, USA.,The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Center of Excellence
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Arenas Jiménez MD, Navarro González JF. How to improve adherence the captors of phosphorus on hemodialysis: Experience in real life with sucroferric oxyhydroxide. Nefrologia 2020; 40:640-646. [PMID: 32564940 DOI: 10.1016/j.nefro.2020.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/03/2020] [Accepted: 04/03/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The lack of adherence to phosphate -binders (PB) is the most important factor in not achieving the objectives of serum phosphorus (sP). Studies in the real-world population are needed to understand the influence of PBs on adherence and how to modify it. METHODS Prospective study conducted during 3 months in usual clinical practice. Out of 105 hemodialysis patients, 57 were switched to SFOH and 48 maintained their baseline treatment (control group). sP levels and the percentage of patients with sP levels <5mg/dl were compared. Adherence before and after introduction of SFOH, number of pills of PB, preferences in the administration mode and side effects were analyzed. RESULTS The percentage of patients with controlled sP (<5mg/dl) increased significantly in the SFOH users' group (62.1-92.9%, p<0.001), but not in the control group (83-83.3%, p=NS). The average of daily tablets decreased significantly in the SFOH group (7.2-2.3 comp, p<0.001), but not in the control group (5.6-5.6, p=NS) and 100% of the patients used only one PB in SFOH group. The use of SFOH increased the adherence according to the SMAQ questionnaire (57.8-84.3%; OR 13.1, p<0.001). The possibility to choose the preferred mode of administration (split-swallowing 89% compared to chewing 11%), improved the acceptance (44.7-78%). 14% of the patients experienced side effects and in 5.2% SFOH was discontinued for this reason. CONCLUSIONS SFOH controlled serum sP in 93% of patients, 100% in monotherapy, and with fewer tablets. The exploration and adaptation of preferences in the mode of administration influenced the acceptance of the drug by the patient and, probably, the future adherence.
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Affiliation(s)
- M Dolores Arenas Jiménez
- Nephrology Department, Hospital Vithas Perpetuo Internacional, Alicante, Spain; Nephrolgy Department, Hospital del Mar, Barcelona, Spain.
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Amano H, Ohno Y, Inoue T, Tomori K, Ohama K, Okada H. Regional prescription surveillance of phosphate binders in the western Saitama area: the substantial role of ferric citrate hydrate in improving serum phosphorus levels and erythropoiesis. Clin Exp Nephrol 2019; 23:841-851. [PMID: 30783915 DOI: 10.1007/s10157-019-01715-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 02/09/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND In April 2015, five types of phosphate binders (PBs) were available by prescription in Japan, namely calcium carbonate, sevelamer hydrochloride, lanthanum carbonate, bixalomer, and ferric citrate hydrate (FeC). FeC reduces serum phosphorus levels and increases the body's iron stores. However, it is unclear whether FeC lowers serum phosphorus relative to other agents in a regional practical setting. METHODS We performed a retrospective observational cohort study of regional hemodialysis surveillance in the western Saitama area of Japan, which included 1374 hemodialysis patients enrolled from 32 satellite dialysis units. The clinical data and prescribing information were retrospectively collected and analyzed. The difference in serum phosphorus among the groups administered five types of PBs (new or additional) from April to September 2015 was the primary outcome. RESULTS As of April 2015, the median values of serum phosphorus, corrected calcium, and intact parathyroid hormone were 5.4 mg/dL, 9.1 mg/dL, and 147 pg/dL, respectively (N = 1374). Unexpectedly, with an increase in the number of PBs administered, serum phosphorous levels increased (p < 0.001). The significant changes in the serum phosphorus and hemoglobin levels were associated with the prescription of FeC but not with that of the other PBs. CONCLUSIONS This regional survey suggests that serum phosphorus is well managed and that FeC has the potential to reduce the serum phosphorus level relative to other PBs and to ameliorates anemia.
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Affiliation(s)
- Hiroaki Amano
- Department of Nephrology, Faculty of Medicine, Saitama Medical University, 38, Morohongo, Moroyama-machi, Irumagun, Saitama, Japan
| | - Yoichi Ohno
- Department of Nephrology, Faculty of Medicine, Saitama Medical University, 38, Morohongo, Moroyama-machi, Irumagun, Saitama, Japan.,Community Health Science Center, Saitama Medical University, 38, Morohongo, Moroyama-machi, Irumagun, Saitama, Japan
| | - Tsutomu Inoue
- Department of Nephrology, Faculty of Medicine, Saitama Medical University, 38, Morohongo, Moroyama-machi, Irumagun, Saitama, Japan
| | - Koji Tomori
- Department of Nephrology, Faculty of Medicine, Saitama Medical University, 38, Morohongo, Moroyama-machi, Irumagun, Saitama, Japan
| | - Kazuya Ohama
- Hemodialysis Unit, Saitama Medical University, 38, Morohongo, Moroyama-machi, Irumagun, Saitama, Japan
| | - Hirokazu Okada
- Department of Nephrology, Faculty of Medicine, Saitama Medical University, 38, Morohongo, Moroyama-machi, Irumagun, Saitama, Japan.
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Al Salmi I, Larkina M, Wang M, Subramanian L, Morgenstern H, Jacobson SH, Hakim R, Tentori F, Saran R, Akiba T, Tomilina NA, Port FK, Robinson BM, Pisoni RL. Missed Hemodialysis Treatments: International Variation, Predictors, and Outcomes in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2018; 72:634-643. [PMID: 30146421 DOI: 10.1053/j.ajkd.2018.04.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 04/26/2018] [Indexed: 02/08/2023]
Abstract
RATIONALE & OBJECTIVE Missed hemodialysis (HD) treatments not due to hospitalization have been associated with poor clinical outcomes and related in part to treatment nonadherence. Using data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) phase 5 (2012-2015), we report findings from an international investigation of missed treatments among patients prescribed thrice-weekly HD. STUDY DESIGN Prospective observational study. SETTING & PARTICIPANTS 8,501 patients participating in DOPPS, on HD therapy for more than 120 days, from 20 countries. Longitudinal and cross-sectional analyses were performed based on the 4,493 patients from countries in which 4-month missed treatment risk was > 5%. PREDICTORS The main predictor of patient outcomes was 1 or more missed treatments in the 4 months before DOPPS phase 5 enrollment; predictors of missed treatments included country, patient characteristics, and clinical factors. OUTCOMES Mortality, hospitalization, laboratory measures, patient-reported outcomes, and 4-month missed treatment risk. ANALYTICAL APPROACH Outcomes were assessed using Cox proportional hazards, logistic, and linear regression, adjusting for case-mix and country. RESULTS The 4-month missed treatment risk varied more than 50-fold across all 20 DOPPS countries, ranging from < 1% in Italy and Japan to 24% in the United States. Missed treatments were more likely with younger age, less time on dialysis therapy, shorter HD treatment time, lower Kt/V, longer travel time to HD centers, and more symptoms of depression. Missed treatments were positively associated with all-cause mortality (HR, 1.68; 95% CI, 1.37-2.05), cardiovascular mortality, sudden death/cardiac arrest, hospitalization, serum phosphorus level > 5.5mg/dL, parathyroid hormone level > 300pg/mL, hemoglobin level < 10g/dL, higher kidney disease burden, and worse general and mental health. LIMITATIONS Possible residual confounding; temporal ambiguity in the cross-sectional analyses. CONCLUSIONS In the countries with a 4-month missed treatment risk > 5%, HD patients were more likely to die, be hospitalized, and have poorer patient-reported outcomes and laboratory measures when 1 or more missed treatments occurred in a 4-month period. The large variation in missed treatments across 20 nations suggests that their occurrence is potentially modifiable, especially in the United States and other countries in which missed treatment risk is high.
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Affiliation(s)
| | - Maria Larkina
- Arbor Research Collaborative for Health, Ann Arbor, MI
| | - Mia Wang
- University of Michigan, Ann Arbor, MI
| | | | - Hal Morgenstern
- Department of Epidemiology, Medical School, University of Michigan, Ann Arbor, MI; Department of Environmental Health Sciences, Medical School, University of Michigan, Ann Arbor, MI; School of Public Health, and Department of Urology, Medical School, University of Michigan, Ann Arbor, MI
| | | | | | - Francesca Tentori
- Arbor Research Collaborative for Health, Ann Arbor, MI; Vanderbilt University, Nashville, TN
| | | | | | | | - Friedrich K Port
- Arbor Research Collaborative for Health, Ann Arbor, MI; University of Michigan, Ann Arbor, MI
| | - Bruce M Robinson
- Arbor Research Collaborative for Health, Ann Arbor, MI; University of Michigan, Ann Arbor, MI
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Umeukeje EM, Mixon AS, Cavanaugh KL. Phosphate-control adherence in hemodialysis patients: current perspectives. Patient Prefer Adherence 2018; 12:1175-1191. [PMID: 30013329 PMCID: PMC6039061 DOI: 10.2147/ppa.s145648] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES This review summarizes factors relevant for adherence to phosphate-control strategies in dialysis patients, and discusses interventions to overcome related challenges. METHODS A literature search including the terms "phosphorus", "phosphorus control", "hemo-dialysis", "phosphate binder medications", "phosphorus diet", "adherence", and "nonadherence" was undertaken using PubMed, PsycInfo, CINAHL, and Embase. RESULTS Hyperphosphatemia is associated with cardiovascular and all-cause mortality in dialysis patients. Management of hyperphosphatemia depends on phosphate binder medication therapy, a low-phosphorus diet, and dialysis. Phosphate binder therapy is associated with a survival benefit. Dietary restriction is complex because of the need to maintain adequate protein intake and, alone, is insufficient for phosphorus control. Similarly, conventional hemodialysis alone is insufficient for phosphorus control due to the kinetics of dialytic phosphorus removal. Thus, all three treatment approaches are important contributors, with dietary restriction and dialysis as adjuncts to the requisite phosphate binder therapy. Phosphate-control adherence rates are suboptimal and are influenced directly by patient, provider, and phosphorus-control strategy-related factors. Psychosocial factors have been implicated as influential "drivers" of adherence behaviors in dialysis patients, and factors based on self-motivation associate directly with adherence behavior. Higher-risk subgroups of nonadherent patients include younger dialysis patients and non-whites. Provider attitudes may be important - yet unaddressed - determinants of adherence behaviors of dialysis patients. CONCLUSION Adherence to phosphate binders, low-phosphorus diet, and dialysis prescription is suboptimal. Multicomponent strategies that concurrently address therapy-related factors such as side effects, patient factors targeting self-motivation, and provider factors to improve attitudes and delivery of culturally sensitive care show the most promise for long-term control of phosphorus levels. Moreover, it will be important to identify patients at highest risk for lack of control, and for programs to be ready to deliver flexible person-centered strategies through training and dedicated resources to align with the needs of all patients.
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Affiliation(s)
- Ebele M Umeukeje
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA,
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville TN, USA,
- Vanderbilt Center for Health Services Research, Nashville, TN, USA,
| | - Amanda S Mixon
- Vanderbilt Center for Health Services Research, Nashville, TN, USA,
- Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kerri L Cavanaugh
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA,
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville TN, USA,
- Vanderbilt Center for Health Services Research, Nashville, TN, USA,
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Araújo MJS, Silva LF, Martins MTS, Matos CM, Lopes MB, Santos RFS, Santos L, Kraychete AC, Martins MTS, Silva FA, Lopes AA. A 3-day diary of dietary protein and calorie intake by serum phosphate concentration and binder use in hemodialysis patients. Int J Artif Organs 2017; 41:0. [PMID: 29148025 DOI: 10.5301/ijao.5000654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The use of phosphate binders to control hyperphosphatemia may allow diets less restricted in protein and calories for maintenance hemodialysis (MHD) patients. The study compared intakes of protein, calorie and phosphate among MHD patients with different serum phosphate concentrations, taking into account binder use. The hypothesis was that low serum phosphate would be associated with low intakes of protein and calories only in patients not on binders. METHODS A cross-sectional study of 443 patients enrolled in the Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO) in Salvador, Brazil, with stratified sampling on serum phosphate: ≤3.0 (n = 41), 3.5-5.5 (n = 328) and ≥7.0 mg/dL (n = 74). A 3-day diet diary was used to determine dietary intakes. RESULTS Approximately 49.0% confirmed binder use. Covariate-adjusted linear regression showed that associations between dietary intakes and serum phosphate were modified by the binder use. In patients not on binders, protein intake was >20% lower for serum phosphate ≤3.0 mg/dL compared to higher concentrations. Also in those not on binders, calorie intake was >30% lower for serum phosphate ≤3.0 mg/dL compared to ≥7.0 mg/dL. Differences in dietary intakes by serum phosphate were virtually absent in patients on binders. CONCLUSIONS The results are consistent with the hypothesis that low serum phosphate is associated with low protein and calorie intake only among MHD patients not on binders. This study supports recommendations to prevent hyperphosphatemia in MHD patients by adequate combination of binder use and selection of foods restricted in phosphors but not severely restricted in protein and calories.
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Affiliation(s)
- Meiry J S Araújo
- NEPHRON Clinic, Salvador, BA - Brazil
- Post-Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA - Brazil
| | - Luciana F Silva
- Post-Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA - Brazil
- Department of Life Sciences, University of the State of Bahia, Salvador, BA - Brazil
- Nephrology and Dialysis Institute (INED), Salvador, BA - Brazil
| | - Maria T S Martins
- NEPHRON Clinic, Salvador, BA - Brazil
- Post-Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA - Brazil
| | - Cacia M Matos
- Post-Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA - Brazil
- Nephrology and Dialysis Institute (INED), Salvador, BA - Brazil
| | - Marcelo B Lopes
- Post-Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA - Brazil
| | - Rilma F S Santos
- NEPHRON Clinic, Salvador, BA - Brazil
- Post-Graduate Program in Health Sciences, Federal University of Bahia, Salvador, BA - Brazil
| | - LarissaS Santos
- NEPHRON Clinic, Salvador, BA - Brazil
- Kidney and Hyptertension Clinic (CLINIRIM), Salvador, BA - Brazil
| | - Angiolina C Kraychete
- Post-Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA - Brazil
- Nephrology and Dialysis Institute (INED), Salvador, BA - Brazil
| | - Márcia T S Martins
- Post-Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA - Brazil
- Kidney and Hyptertension Clinic (CLINIRIM), Salvador, BA - Brazil
| | - Fernanda A Silva
- NEPHRON Clinic, Salvador, BA - Brazil
- Post-Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA - Brazil
| | - Antonio A Lopes
- Department of Internal Medicine and Diagnostic Support, Federal University of Bahia, Salvador, BA - Brazil
- Center for Clinical Epidemiology and Evidence-Based Medicine, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, BA - Brazil
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Milazi M, Bonner A, Douglas C. Effectiveness of educational or behavioral interventions on adherence to phosphate control in adults receiving hemodialysis: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:971-1010. [PMID: 28398983 DOI: 10.11124/jbisrir-2017-003360] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND People with end-stage kidney disease (ESKD) develop impaired excretion of phosphate. Hyperphosphatemia develops in ESKD as a result of the kidney's reduced ability to excrete ingested phosphate load and is characterized by high bone turnover and increased musculoskeletal morbidity including bone pain and muscle weakness. Increased serum phosphate levels are also associated with cardiovascular disease and associated mortality. These effects are significant considering that cardiovascular disease is the leading cause of death in ESKD, making phosphate control a crucial treatment goal. OBJECTIVES To determine the effectiveness of education or behavioral interventions on adherence to phosphate control in adults with ESKD receiving hemodialysis (HD). INCLUSION CRITERIA TYPES OF PARTICIPANTS Adults aged over 18 years with ESKD undergoing HD, attending dialysis facilities regardless of frequency and duration of treatment sessions per week. Studies with participants receiving hemodiafiltration were excluded. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST All types of educational and behavioral interventions aimed at improving adherence to dietary phosphate restriction, phosphate binder medication and HD. TYPES OF STUDIES Randomized controlled trials (RCTs), non-RCTs, before and after and cohort studies. OUTCOMES Outcome measures included serum phosphate levels, patient knowledge and adherence to phosphate control methods, chronic kidney disease (CKD) self-management behavior and perceived self-efficacy for CKD related to phosphate control. SEARCH STRATEGY A search was conducted in CINAHL, MEDLINE, The Cochrane Library, Embase, Web of Science, PsycINFO and ProQuest Dissertations and Theses Global to find published studies between January 2005 and December 2015. METHODOLOGICAL QUALITY Risk of bias was assessed by three reviewers prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). DATA EXTRACTION Data were extracted using the standardized data extraction tool from JBI-MAStARI. DATA SYNTHESIS Data were pooled using JBI software. Mean differences (95% confidence interval [CI]) and effect size estimates were calculated for continuous outcomes. Meta-analysis using a random-effects model was performed for serum phosphate levels, and where the findings could not be pooled using meta-analysis, results have been presented in a narrative form. Standard GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence assessment of outcomes has been reported. RESULTS A total of 18 studies were included in the review: seven studies focused on dietary phosphate, four studies focused on medications (phosphate binders) and six studies focused on dietary phosphate and medications. Only one study taught patients about diet, medications and HD to control phosphate. Sixteen studies showed significant improvements in phosphate levels. Meta-analysis of eight RCTs favored educational or behavioral interventions over standard care for serum phosphate control, with a weighted mean reduction of -0.23 mmol/l (95% CI -0.37, -0.08) in treatment groups. CONCLUSION Overall, educational or behavioral interventions increase adherence to phosphate control. Studies in this systematic review revealed improved outcomes on serum phosphate levels, patient knowledge and adherence to phosphate control methods, CKD self-management behavior and perceived self-efficacy for CKD related to phosphate control. However, there is a lack of sufficient data on how some of the studies implemented their interventions, suggesting that further research is required. Successful strategies that improve and optimize long-term adherence to phosphate control still need to be formulated.
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Affiliation(s)
- Molly Milazi
- 1School of Nursing, Queensland University of Technology, Brisbane, Australia 2Renal Nursing Professorial Unit, Kidney Health Services, Royal Brisbane and Women's Hospital, Brisbane, Australia 3CEBHA (Centre for Evidence-Based Healthy Ageing): a Joanna Briggs Institute Centre of Excellence
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Ruiz García E, Latorre López LI, Delgado Ramírez A, Crespo Montero R, Sánchez Laguna JL. Adherencia al tratamiento farmacológico de los pacientes en hemodiálisis. ENFERMERÍA NEFROLÓGICA 2016. [DOI: 10.4321/s2254-28842016000300005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción: La mala adherencia a largo plazo es reconocida como uno de los principales problemas clínicos en la gestión de las enfermedades crónicas, y en concreto de la enfermedad renal crónica avanzada.
Objetivo: Conocer la producción científica sobre el grado de adherencia al tratamiento farmacológico en pacientes en hemodiálisis.
Metodología: Se ha realizado una revisión sistemática no metaanalítica mediante una búsqueda en las bases de datos de Scielo, PubMed y Google Académico. Se incluyeron artículos escritos en inglés y español. Se analizaron los artículos que trataban la adherencia al tratamiento en pacientes en hemodiálisis.
Resultados: Se han revisado 19 artículos, 6 revisiones y 13 estudios observacionales, publicados entre el 2007 y 2015. Se estudiaron variables sociodemográficas: edad, género, nivel socioeconómico y estudios, estado civil, raza y situación laboral; variables clínicas y psicosociales y, factores relacionados con la medicación. Se encontró que entre 15-72% de los pacientes en hemodiálisis presentan falta de adherencia al tratamiento farmacológico. La depresión se encuentra asociada a la falta de adherencia. La edad se asocia a mayor adherencia.
Conclusiones: Los pacientes en hemodiálisis presentan con frecuencia falta de adherencia al tratamiento farmacológico, aunque con una gran variabilidad,debido a las diferencias en la definición y medición de la falta de adherencia. La depresión parece ser el predictor más influyente en la falta de adhesión. Los factores demográficos y clínicos no están consistentemente asociados con la falta de adherencia, a excepción de la edad, siendo los pacientes de mayor edad los que presentan mayor adherencia.
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Ghimire S, Castelino RL, Lioufas NM, Peterson GM, Zaidi STR. Nonadherence to Medication Therapy in Haemodialysis Patients: A Systematic Review. PLoS One 2015; 10:e0144119. [PMID: 26636968 PMCID: PMC4670103 DOI: 10.1371/journal.pone.0144119] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/15/2015] [Indexed: 11/19/2022] Open
Abstract
Background End-stage kidney disease (ESKD) patients are often prescribed multiple medications. Together with a demanding weekly schedule of dialysis sessions, increased number of medicines and associated regimen complexity pre-dispose them at high risk of medication nonadherence. This review summarizes existing literature on nonadherence and identifies factors associated with nonadherence to medication therapy in patients undergoing haemodialysis. Methods A comprehensive search of PubMed, Embase, CINAHL, PsycInfo, and Cochrane Database of Systematic Reviews covering the period from 1970 through November 2014 was performed following a predefined inclusion and exclusion criteria. Reference lists from relevant materials were reviewed. Data on study characteristics, measures of nonadherence, prevalence rates and factors associated with nonadherence were collected. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was followed in conducting this systematic review. Results Of 920 relevant publications, 44 were included. The prevalence of medication nonadherence varied from 12.5% to 98.6%, with widespread heterogeneity in measures and definitions employed. Most common patient-related factors significantly associated with nonadherence were younger age, non-Caucasian ethnicity, illness interfering family life, being a smoker, and living single and being divorced or widowed. Similarly, disease-related factors include longevity of haemodialysis, recurrent hospitalization, depressive symptoms and having concomitant illness like diabetes and hypertension. Medication-related factors such as daily tablet count, total pill burden, number of phosphate binders prescribed and complexity of medication regimen were also associated with poor adherence. Conclusions A number of patient-, disease-, and medication-related factors are associated with medication nonadherence in haemodialysis patients. Clinicians should be aware of such factors so that adherence to medications can be optimised in haemodialysis patients. Future research should be directed towards well-designed prospective longitudinal studies developing standard definitions and validating available measurement tools, while focusing on the role of additional factors such as psychosocial and behavioural factors in predicting nonadherence to medications.
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Affiliation(s)
- Saurav Ghimire
- Unit for Medication Outcomes Research and Education, Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Ronald L. Castelino
- Unit for Medication Outcomes Research and Education, Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
| | | | - Gregory M. Peterson
- Unit for Medication Outcomes Research and Education, Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Syed Tabish R. Zaidi
- Unit for Medication Outcomes Research and Education, Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
- * E-mail:
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Schmid H, Lederer SR. Novel iron-containing phosphate binders for treatment of hyperphosphatemia. Expert Opin Pharmacother 2015; 16:2179-91. [PMID: 26293683 DOI: 10.1517/14656566.2015.1079622] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Hyperphosphatemia is a frequent complication of chronic kidney disease and is associated with increased mortality. Despite side effects, risk of accumulation and high costs, phosphate binders (PBs) have become the crucial cornerstone of therapy. The iron-containing PB sucroferric oxyhydroxide (SO) and ferric citrate hydrate (FCH) have entered the market and other candidates are prior market entry. AREAS COVERED A literature search was performed using MEDLINE and EMBASE databases to identify references on iron-containing PB with particular regard to efficacy, safety and potential benefits. Additional hand searches were conducted along with a full-text review of any citation that appeared relevant. EXPERT OPINION On the highly competitive market, where the 'ideal' PB is still unknown, novel substances that offer clear benefits over available drugs are desired. Although SO and FCH showed similar efficacy and safety compared to sevelamer, head-to-head studies with lanthanum carbonate are absent. Clinical 1-year data in a limited patient cohort suggested improved adherence for SO and a large randomized controlled trial showed significant reduction in hospitalizations and costs for FCH. Additional large randomized controlled trials have now to prove these possible advantages. Cost-effectiveness in comparison to other PB and the exclusion of significant harms under long-term treatment will determine the future use of both drugs.
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Affiliation(s)
- Holger Schmid
- a 1 KFH Nierenzentrum Muenchen Laim , Elsenheimerstr. 63, D-80687 Munich, Germany +49 8 95 47 26 70 ; +49 8 95 70 57 27 ;
| | - Stephan R Lederer
- b 2 Munich University Hospital, Clinic and Policlinic IV, Section of Nephrology , Munich, Germany
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Milazi M, Bonner A, Douglas C. The effectiveness of education or behavioral interventions on adherence to phosphate control in adults receiving hemodialysis: a systematic review protocol. ACTA ACUST UNITED AC 2015; 13:91-102. [DOI: 10.11124/jbisrir-2015-1880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 12/11/2014] [Accepted: 01/23/2015] [Indexed: 01/21/2023]
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Patel P, Antoniou S, Popat R. Unintentional non-adherence to phosphate binders. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2014-000456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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