Hyperphosphatemia Control: A Quality Improvement Initiative for Adult End-Stage Renal Disease Patients on Hemodialysis.

Abstract

Background: Hyperphosphatemia is a modifiable risk factor for cardiovascular morbidity and mortality in patients on hemodialysis. However, despite efforts to control hyperphosphatemia, it remains a prevalent issue among adult patients on maintenance hemodialysis worldwide. Objectives: An intensive multidisciplinary educational program focusing on diet control and medication compliance was developed to lower the incidence rate of hyperphosphatemia and serum phosphorus levels among adult patients on hemodialysis and to improve their understanding of hyperphosphatemia control. The objectives were to decrease the incidence rate of hyperphosphatemia and the mean phosphorus level among participants by 10% and to improve their knowledge assessment scores by 30% within 3 months. Methods: The education program was implemented at a hemodialysis clinic serving adult end-stage renal disease patients. Education was delivered via videos, pamphlets, and bimonthly one-on-one follow-up sessions. The incidence rate of hyperphosphatemia, mean serum phosphorus levels, and knowledge assessment scores were measured before and after the intervention. Descriptive and comparison statistics were used in data analysis. Results: Following the intervention, the incidence rate of hyperphosphatemia decreased by 45% within the intervention group and by 18% across the entire dialysis clinic. The mean serum phosphorus level within the intervention group decreased by 16% after intervention (p = .007). Additionally, the intervention group showed a statistically significant improvement in knowledge assessment test scores (p = .018). Conclusion: The intensive multidisciplinary education program effectively educated patients with hyperphosphatemia about phosphorus control, reduced the incidence rate of hyperphosphatemia, and helped lower serum phosphorus levels to within a normal range. Implications for Nursing Practice: Advanced practice registered nurses can play an important role in improving patient outcomes and management of hyperphosphatemia.