phosphorus levels and treatment adherence in patients with ... 71... · phosphorus levels and...
TRANSCRIPT
Phosphorus levels and treatment adherence in patients
with chronic kidney disease on haemodialysis
António Saraiva
Valencia, 19th, September
EDTNA/ERCA 17-20.09.2016 Phosphorus levels and treatment adherence in patients with chronic kidney disease on haemodialysis, António Saraiva © FMC - P
Page 2
Presentation outline
Introduction
1
Objectives
2
Methods
3
Preliminary Results
4
Conclusions
5
EDTNA/ERCA 17-20.09.2016 Phosphorus levels and treatment adherence in patients with chronic kidney disease on haemodialysis, António Saraiva © FMC - P
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Hyperphosphatemia in patients undergoing haemodialysis treatments is associated with major health problems. This situation is often associated with non-adherence to treatment.
Authors highlight the need of implementing measures to overcome obstacles on adherence to the treatment.
The lack of knowledge is considered the main obstacle for non-adherence to therapy, therefore, training patients is one of the solutions.
The authors address this issue on two different and dissociated perspectives: pharmacological or nutritional. Therefore we need a interdisciplinary approach that includes these two perspectives.
Introduction
EDTNA/ERCA 17-20.09.2016 Phosphorus levels and treatment adherence in patients with chronic kidney disease on haemodialysis, António Saraiva © FMC - P
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To analyse the relation between phosphorus levels and
adherence to drug therapy and nutrition recommendations;
To assess the impact of a interdisciplinary education program
on phosphorus levels and treatment adherence.
Objectives
EDTNA/ERCA 17-20.09.2016 Phosphorus levels and treatment adherence in patients with chronic kidney disease on haemodialysis, António Saraiva © FMC - P
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Methods
Inclusion criteria:
- Patients who were taking phosphate binders in the beginning of the study (OsvaRen®, Phosphosorb®, Renvela®);
- Patients on Haemodialysis program for at least 4 months;
- Non-institutionalized patients;
- Patients with cognitive ability;
- Patients with an average of phosphorus levels > 3.5 mg/dl over the last 3 months;
This is a quantitative, descriptive, correlational and analytical study
that consists on the implementation of a interdisciplinary education
program for three months.
EDTNA/ERCA 17-20.09.2016 Phosphorus levels and treatment adherence in patients with chronic kidney disease on haemodialysis, António Saraiva © FMC - P
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Methods
n= 45 patients
n= 48 patients Dropouts: (3 Patients)
- 1 Patient hospitalized
- 2 Patients refused
N= 164 patients
Inclusion criteria
EDTNA/ERCA 17-20.09.2016 Phosphorus levels and treatment adherence in patients with chronic kidney disease on haemodialysis, António Saraiva © FMC - P
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Methods
n= 45 patients
Group A n = 17
Phosphorus levels between 3.5 and
5 mg/dl on average over the
last 3 months
Out of the education program
Group B
n = 17
Phosphorus levels between 3.5 and
5 mg/dl on average over the
last 3 months
In the education program
Group C n = 11
Phosphorus levels higher 5 mg/dl over the last 3
months
In the education program
EDTNA/ERCA 17-20.09.2016 Phosphorus levels and treatment adherence in patients with chronic kidney disease on haemodialysis, António Saraiva © FMC - P
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Methods
1st Stage
• Initial assessment of the treatment adherence of patients in
groups A , B and C.
• Adherence to medication was assessed by Measure Treatment
Adherence scale.
• Adherence to nutritional recommendations was assessed through a
questionnaire of knowledge and attitudes about nutrition and food
intake record.
EDTNA/ERCA 17-20.09.2016 Phosphorus levels and treatment adherence in patients with chronic kidney disease on haemodialysis, António Saraiva © FMC - P
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Methods
2nd Stage
- Application of a interdisciplinary education program in groups B
and C, for 3 months.
- This program includes the nutritional and pharmacological
perspective:
Through a group session and two individualized training sessions about
nutrition.
Three individualized training sessions about phosphate binders.
EDTNA/ERCA 17-20.09.2016 Phosphorus levels and treatment adherence in patients with chronic kidney disease on haemodialysis, António Saraiva © FMC - P
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Methods
PATIENTS NUTRITIONIST
Group sessions
Nutrition
NURSE
Individual sessions
Phosphate binders
1st Month: February 2016
1st Training Session
EDTNA/ERCA 17-20.09.2016 Phosphorus levels and treatment adherence in patients with chronic kidney disease on haemodialysis, António Saraiva © FMC - P
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Methods
2nd Month: March 2016 3rd Month: April 2016
2nd/3rd Training Sessions
NURSE
Individual sessions
Phosphate binders
Nutrition
PATIENTS
EDTNA/ERCA 17-20.09.2016 Phosphorus levels and treatment adherence in patients with chronic kidney disease on haemodialysis, António Saraiva © FMC - P
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Methods
3rd Stage
- Assessment of the patients’ treatment adherence in groups A, B and C after the education program.
- Application of the Measure Treatment Adherence Scale and questionnaire of knowledge and attitudes about nutrition and food intake.
- Analysis of the average of phosphorus levels of the three months during and after the education program in group A, B and C.
EDTNA/ERCA 17-20.09.2016 Phosphorus levels and treatment adherence in patients with chronic kidney disease on haemodialysis, António Saraiva © FMC - P
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Methods
Statistics Methodology
Descriptive statistics: Average and Standard
Deviation
Comparison study between different time
points – Paired Samples T Student Test;
Non Parametric Wilcoxon Test.
Significance level : ρ≤0,05.
EDTNA/ERCA 17-20.09.2016 Phosphorus levels and treatment adherence in patients with chronic kidney disease on haemodialysis, António Saraiva © FMC - P
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Preliminary Results
SAMPLE
CARACTERISATION
Group A Group
B
Group
C
n 17 17 11
Male 52,9% 64,7% 81,8%
Female 47,1% 35,3% 18,2%
Age (average) 71,94 67,76 57,45
Vascular Access
AVF/Graft 82,4% 88,2% 90,9%
CVC 17,16% 11,8% 9,1%
Time in Dialysis (years) 4,76 6,65 3,18
Residual Function
Yes 52,9% 70,6% 81,8%
No 47,1% 29,4% 18,2%
Diabetes
Yes 52,9% 17,6% 18,2%
No 47,1% 82,4% 81,8%
EDTNA/ERCA 17-20.09.2016 Phosphorus levels and treatment adherence in patients with chronic kidney disease on haemodialysis, António Saraiva © FMC - P
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Preliminary Results
38 39 40 41
Group A
Group B
Group C
Measure Treatment Adherence Scale
After Education
Program
Before Education
Program
p=0,233
p=0,005
p=0,782
EDTNA/ERCA 17-20.09.2016 Phosphorus levels and treatment adherence in patients with chronic kidney disease on haemodialysis, António Saraiva © FMC - P
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Preliminary Results
0
1
2
3
4
5
6
Group A Group B Group C
Before Education Program 4,46 4,23 5,54
After Education Program 4,46 4,57 5,74
Phosphoru
s L
evels
Analysis of the impact of the education program based on average of the first 3 Months after the Education
Program´s beginning.
p=0,989 p=0,027
p=0,494
EDTNA/ERCA 17-20.09.2016 Phosphorus levels and treatment adherence in patients with chronic kidney disease on haemodialysis, António Saraiva © FMC - P
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• Preliminary results show that the education program:
- Increased adherence to phosphate binders, but…
- Was not efficient on improving the phosphorus levels as
expected
Is better adherence to phosphate binders associated to
less concern with nutritional behaviors??
Conclusions
EDTNA/ERCA 17-20.09.2016 Phosphorus levels and treatment adherence in patients with chronic kidney disease on haemodialysis, António Saraiva © FMC - P
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EDTNA/ERCA 17-20.09.2016 Phosphorus levels and treatment adherence in patients with chronic kidney disease on haemodialysis, António Saraiva © FMC - P
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Bibliography
- CEGEA DA UNIVERSIDADE CATÓLICA PORTUGUESA (2007). Estrutura de Mercado e Performance nos Serviços de Hemodiálise em Portugal. [Em linha]. [Consult. 21 de Novembro de 2015]. Disponível em <https://www.ers.pt/uploads/writer_file/document/99/825007_rel.pdf > - SANDLIN K. et al (2013). The impact of nurse-led education on haemodialysis patients’ phosphate binder medication adherence. Journal of Renal Care 39(1), 12–18. - MARTINS et al. (2013). Potentially modifiable factors associated with non-adherence to phosphate binder use in patients on hemodialysis. BMC Nephrology, 14:208. -SAN MIGUEL, S., CURTALE, M, KNAGGE, D, NHAN, C & CHOW, J (2009) Improving patient understanding of phosphate binders: A bony challenge. Renal Society of Australasia Journal 5(3) 119-125.
- FOUQUE D. et al (2014). Balancing nutrition and serum phosphorus in maintenance dialysis. American Journal Of Kidney Diseases: The Official Journal Of The National Kidney Foundation; Vol. 64 (1), pp. 143-50. - Cupisti e D’Alessandro (2011). The impact of known and unknown dietary components to phosphorus intake. Giornale Italiano di Nefrologia ; 28 (3): 278-288. - KARAVETIAN M. E GHADDAR S. (2012). Nutritional education for the management of osteodystrophy (NEMO) in patients on haemodialysis: a randomised controlled trial. Journal of Renal Care 39(1), 1-12. - DELGADO, A.B., & LIMA, M.L. (2001). Contributo para a validação concorrente de uma medida de adesão aos tratamentos. Psicologia: Saúde e Doenças, 1, 81-100.
EDTNA/ERCA 17-20.09.2016 Phosphorus levels and treatment adherence in patients with chronic kidney disease on haemodialysis, António Saraiva © FMC - P
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Acknowledgments
Sandra Ribeiro Nutritionist Fresenius Medical Care – NephroCare Portugal Coimbra – Portugal Alexandra Seabra Head Nurse Fresenius Medical Care – NephroCare Coimbra Coimbra – Portugal Nuno Gomes Deputy Head Nurse Fresenius Medical Care – NephroCare Coimbra Coimbra – Portugal Cristina Antunes Head Nutritionist Fresenius Medical Care – NephroCare Portugal João Fazendeiro Matos Nursing Care Director Fresenius Medical Care – NephroCare Portugal Porto – Portugal Maria Teresa Parisotto Director, Nursing Care Management Fresenius Medical Care NephroCare Coordination Bad Homburg – Germany Clemente Sousa PhD, Nurse Nursing School of Porto Porto - Portugal Rui Camisa Nurse Fresenius Medical Care – NephroCare Coimbra Coimbra – Portugal Lurdes Rosa Clinic Secretary Fresenius Medical Care – NephroCare Coimbra Coimbra – Portugal