Chronic Kidney Disease and Phosphorus Management

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Table of Contents

Current Situation Assessment
Introduction
Target Patient Population
Needs Assessment
Literature Synthesis
Conclusion
References

Current Situation Assessment

Issue or problem related to a disease process	Who is affected by this issue or problem	Desired outcome related to the disease process (measurable)	The current educational method used in relation to the disease process	Difference between the current outcomes and the desired outcomes
Cardiovascular disease (CVD) and overall mortality are both elevated in those with chronic kidney disease (CKD). This high mortality rate is associated with vascular calcification, skeletal and calcium metabolism problems, and classic cardiovascular (CV) health risks such as diabetes and hypertension, which are frequent comorbidities.	“CKD is slightly more common in women (14%) than men (12%); CKD is more common in non-Hispanic Black adults (16%) than non-Hispanic white adults (13%) or non-Hispanic Asian adults (13%); About 14% of Hispanic adults have CKD; CKD is most common among people ages 65 or older (38%), followed by people ages 45 to 64 (12%) and people ages 18 to 44 (6%)” (CDC, 2021).	Serum phosphate concentrations, patient education and compliance to phosphate control techniques, self-management of chronic kidney disease (CKD), and perceived self-efficacy for CKD in relation to phosphate control were all outcome outcomes (Milazi et al., 2017).	The Phosphate Education Program (PEP) offers straightforward training materials that teach individuals to evaluate the phosphorus content of meals using their eyes based on recently established phosphorus equivalents and then self-adjust the amount of phosphorus binder as necessary.	“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” (Milazi et al., 2017). Overall, educational or psychological treatments boost compliance with phosphate control, which is the expected objective.

Introduction

Dietary guidelines for patients with CKD may seem complicated, and adequate dietary management requires careful planning, regular evaluations of nutritional status, and continuous monitoring of dietary compliance. Despite suggestions and an immediate need for thorough nutrition education and professional education for clinicians, the lack of nutrition education has continually been acknowledged as a need for reform in the medical school curriculum for doctors. Dietitians have also been deemed essential in the management of CKD in the setting of primary healthcare; nevertheless, dietitians who do not frequently do renal education may need training on the particular challenges posed by CKD.

For long-term phosphorus level possession, multi-component approaches that simultaneously address therapy-related variables like health consequences and supplier considerations to change perceptions and provide care that is aware of cultural differences show the most promise (Umeukeje et al., 2018). Identifying patients who are most at risk of disease will also be crucial, and programs must be prepared to offer adaptable person-centered techniques through training and devoted personnel to fulfill the demand of all individuals.

The patient’s lack of understanding of the relevance of adopting dietary adjustments to decrease phosphorus levels is one of the barriers to health participation, even if patient education might help them better regulate their phosphate concentrations. Patients with CKD who do not control their diet commonly suffer from high levels of phosphorus. An improvement in staff knowledge will lead to better patient education and might raise the bar for treating CKD patients. Education programs aimed at staff and patients are successful in the management of CKD.

Not much emphasis is placed on using academic resources to teach CKD patients with hyperphosphatemia about phosphorus control. Controlling serum phosphorus is essential for reducing the risks of mortality and cardiovascular events in CKD patients. Hyperphosphatemia is a mortality predictor for severe CKD and can be managed with phosphorus binders, dialysis, and patient dietary adjustments. Patient education has not been effective in decreasing the blood phosphorus levels of CKD patients. As a consequence, phosphate binders and medicine for kidney transplants are more successful in the early stages of CKD than phosphorus educational administration.

Target Patient Population

In the United States, 37 million adults have chronic kidney disease (CKD). The danger of CKD is even more significant for Americans with hypertension and diabetes, the two most popular factors that cause kidney failure (CDC, 2021). Additional factors that can cause kidney disease includes cardiovascular disease and a family background of renal failure. “CKD is slightly more common in women (14%) than men (12%); CKD is more common in non-Hispanic Black adults (16%) than non-Hispanic white adults (13%) or non-Hispanic Asian adults (13%);” (CDC, 2021). People with lower incomes and worse education are more likely to have the disease, nearly twice the rate.

At the same time, people from poorer areas of the United States have a higher chance of getting the disease (CDC, 2021). Thus, individuals with healthy lifestyles and comfortable living conditions are not susceptible to this disease. It should be noted that chronic renal failure is incurable, but early detection and diagnosis, diet correction, regular monitoring, and proper treatment delay the development of the disease (CDC, 2021). Accordingly, people who practice a religion that supports medical treatment and high values, attitudes, and a healthy lifestyle have a better chance of managing the disease.

Needs Assessment

To enhance medical practice and the performance of nursing, patient observation on their own health, it is essential to adhere to a training program.The Phosphate Education Program (PEP) provides simple instructional materials that show people how to assess the phosphorus content of food using their eyes and recently developed phosphorus equivalents (Teong et al., 2022). The expected outcome is improved staff knowledge that will lead to better patient education and may raise the bar in the care of patients with CKD.

This will solve the problem of insufficient professionalism of the staff. The training is designed to help patients listen to the advice of doctors and to plan their health according to their recommendations (Dickerson, 2014). The lack of communication and the absence of growth of the medical staff does not allow patients to follow their advice effectively. Thus, simple and grouped training material will allow patients to control their own blood phosphorus levels. In addition, training for medical staff will help support patients and establish communication with them (Teong et al., 2022). The management of CKD is successful when staff and patient education initiatives are implemented.

Literature Synthesis

Hyperphosphatemia, which is linked to unfavorable outcomes, frequently develops in patients with renal impairment and the early stages of chronic kidney disease. It is essential to point out that there are practices that assist in preventing the development of the disease. Regular exercise and physical activity maintain normal blood pressure and control blood sugar (Forfang et al., 2022). Such activities reduce the danger of diabetes and hypertension and decrease the possibility of chronic kidney disease. In addition, supporting weight with a healthy diet and proper physical activity helps avoid chronic kidney disease. This can help prevent diabetes, heart disease, and other conditions associated with chronic kidney disease. At the same time, people should stop smoking; it can lead to atherosclerosis, which reduces blood flow to the kidneys. Kidney disease is often a silent disease and produces no symptoms until the last stage of the disease is reached (Forfang et al., 2022). The most concentrated and effective method of early diagnosis and prevention of kidney disease is to have them regularly screened. The annual examination is required for individuals in the risk groups.

The accepted clinical approach is to lower phosphorus levels. The existing techniques of phosphate administration, nevertheless, result in poor Quality of Life (QoL) in dialysis patients, mainly because patients may not receive appropriate instruction on phosphate control (Forfang et al., 2022). Patients undergoing dialysis are encouraged to keep strict dietary requirements and may struggle with anxiety and sadness as a result of the ongoing responsibility of managing their diets.

Compliance with dietary limitations is made more complex and confusing by the absence of nutritional information on the product labels. The only pharmacologic therapy now recommended for hyperphosphatemia is phosphate binders. Phosphate binders are challenging to integrate into patients’ everyday routines since they have a low binding capacity (Brauer et al., 2019). Novel therapeutics for more efficient phosphate management is required due to the inadequate efficiency of phosphate binders and the detrimental effects of dietary restrictions on patient QoL. Patients might consume a more typical, nutritious diet with the help of new therapy choices that regulate phosphate levels, which may enhance their quality of life.

It is essential to regulate dietary phosphorus at any stage of chronic kidney disease. Since it is well known that lowering meat consumption may result in protein-energy squandering and impaired survival, official guidelines focus on managing phosphorus by lowering preservatives and seeking out natural, unprocessed, low-phosphorus sources of protein. This was in contrast to 20 years ago, when dietitians stressed trying to control phosphorus by limiting protein (Anderson and Nguyen, 2018). Ironically, increasing protein consumption lowers hemodialysis patients’ overall survival unless it is simultaneously followed by a decrease in phosphorus intake.

The use of phosphate binders and diet to achieve the appropriate blood phosphorus levels necessitates patient understanding, active engagement, compliance, and tenacity. Practitioners should emphasize to patients the effects of hyperphosphatemia in CKD-MBD. Clinicians should, for instance, explain to patients the effects of their actions (Brauer et al., 2019). In order to create tailored treatment regimens that match patients’ lives and will eventually increase adherence, close communication between the various members of the renal professional and the patient is necessary, given the complicated pathologies and treatment methods connected with CKD-MBD. The application of regimens for phosphorus management in CKD-MBD can be made better by educating patients and agreement.

Dietary advice should promote the intake of foods with the lowest possible inorganic phosphorus amount, the lowest possible phosphorus-to-protein proportions, and the highest possible protein isolate while maintaining palatability standards. The regulation of serum phosphorus can be significantly impacted by variations in the consumption of nutrition protein and phosphorus bioavailability (Anderson and Nguyen, 2018). In order to empower clients to follow the charge of their dietary protein and phosphorus consumption, educators must arm them with the knowledge and skills necessary to identify and steer clear of nitrogen and phosphorus preservatives, choose adequate sources of protein, and approximate the phosphorus content of particular foods.

Although most phosphate preservation treatments start after hyperphosphatemia, it is essential to address it in the early stages of CKD to maintain phosphorus levels that are near normal. Phosphate accumulation does result in hyperphosphatemia and elevated blood phosphorus levels in CKD patients because of their poor health outcomes. Clinical recommendations stress the significance of appropriate phosphorus levels in predialysis participants, and phosphate administration is a component of CKD care that aims to achieve average levels in patients with chronic kidney disease (Brauer et al., 2019). It is advisable to begin therapy when CKD is still in its early stages in order to keep phosphorus levels close to normal for a longer length of time as the disease progresses (Hsu et al., 2021). Although most conventional systems postpone therapy until blood phosphorus is high, treating CKD patients early is preferable.

Although patient education could help better control their phosphate concentrations, one of the obstacles to health engagement is the patient’s lack of awareness of the significance of making dietary changes to lower phosphorus levels. Patients with CKD who do not regulate their diets frequently have consequences of excessive phosphorus levels (Hsu et al., 2021). An enhancement in staff expertise will result in improved patient education and might help to enhance the standard of treatment for CKD patients (Somuah, 2018). In the management of CKD, educational initiatives aiming at educating staff and patients are effective.

To successfully start and complete an educational program, the program must be based on evidence-based practice with theory to show the program’s success by increasing staff knowledge. Patient education programs are uniquely potent in this regard. Undeniably, whenever trialed or meta-analyzed, patient education has proven to be an effective adjunct to other means of hyperphosphatemia management (Karavetian and Rizk, 2018). It is now well established that frequent, long-term, individualized education delivered by trained healthcare professionals using cognitive and behavioral strategies is a practical approach for managing hyperphosphatemia among hemodialysis patients without compromising their nutritional status.

The paucity of any intervention-related effects may also be explained by the lack of clarification on critical elements to include in a patient education curriculum for the management of the resources of hyperphosphatemia. The durability of at least monthly instruction for more than six months, as well as an emphasis on counseling for behavior interventions rather than just information transfer, maybe the most beneficial element (Shivaprasad et al., 2021). The need to highlight the importance of education programs for the best treatment of hemodialysis patients in regular care is growing within the medical establishment. It is also crucial to understand that, in conjunction with these programs, improving patient awareness alone does not result in changes in behavior or better results, particularly for the treatment of hyperphosphatemia.

Using academic materials to inform CKD patients with hyperphosphatemia about phosphorus regulation is not given much priority. In order to lower the rates of death and cardiovascular events in CKD patients, serum phosphorus control is crucial. With severe CKD, hyperphosphatemia is a morbidity prediction that can be treated with phosphorus binders, dialysis, and dietary changes for the patient (Chan et al., 2019). Patient education has not proven successful in lowering CKD sufferers’ blood phosphorus levels. As a result, in the early stages of CKD, phosphorus management education is not as effective as the use of phosphate binders and kidney transplant medication.

The primary healthcare nurse should utilize the phosphorus pyramid as a standard teaching tool for CKD patients. Patients will receive a brochure with a description of the equipment to serve as a reference manual when they go food shopping. The phosphorus pyramid can help patients discover high-phosphorus meals that should be shunned and low-phosphorus products that are suggested to include in their diet plan. All nurses will receive training on how to instruct all CKD patients, particularly those with hyperphosphatemia, using the phosphorus ladder.

Medical centers and other inpatient healthcare organizations might benefit from the CKD phosphorus management education program with the phosphorus pyramid. Patients suffer from staff knowledge gaps because nurses who are unfamiliar with the subject are unable to counsel patients. The educational program was created using evidence-based practice with a hypothesis to demonstrate program effectiveness by the enhanced staff understanding in order to launch and finish it effectively (Somuah, 2018). Professionals should get training in health education and communication strategies to support patients’ motivation for diet adherence and self-management (Oquendo et al., 2017). It is essential to conduct controlled and randomized medical testing incorporating the predialysis phases to examine the effects of assessing and managing dietary adherence difficulties.

Individuals on hemodialysis have a poor understanding of renal nutrition, although better nutritional phosphorus understanding does not result in decreased blood phosphorus levels. Dangerously, it has been shown that renal nurses have an understanding comparable to that of hemodialysis patients, something that has to be considered while instructing the new dialysis staff (Pafili et al., 2019). Although nephrologists have more outstanding expertise, they still lack fundamental nutritional comprehension that could impair patients’ and nurses’ general comprehension. Renal nurses and nephrologists may benefit from ongoing nutrition education to provide better hemodialysis client nutrition treatment.

It is also crucial to understand that, in combination with these programs, improving patient awareness alone does not result in behavioral changes or better results, particularly for the management of hyperphosphatemia. There is evidence for the claim that hemodialysis patients with superior knowledge actually have worse phosphate management since there are other factors at play in addition to knowledge gaps that contribute to non-adherence to the medication of hyperphosphatemia in end-stage renal illness (Pereira et al., 2021). The patient’s segment of the population, clinical, personal qualities and social and emotional traits are crucial, as are their perceptions of social support from friends, relatives, and the renal staff. Other essential factors encompass food tiredness or slowly losing involvement in the low phosphate eating plan, as well as their religious views about the requirement of and worries about possible adverse effects of phosphate folders.

Conclusion

Thus, patients who need treatment but have religious and personal views about the harms of phosphate folders especially need additional education. It is critical for them to obtain scientific confirmation of the treatment system. At the same time, supplemental instruction for medical personnel will allow them to communicate with patients in a way that is sensitive to their emotional state and personality (Pereira et al., 2021). This will explain the importance of treatment and support them at each stage. Importantly, it is possible to involve specialists who have the same cultural background and will inspire confidence in patients to educate and treat them.

References

Anderson, C. A., & Nguyen, H. A. (2018). Nutrition education in the care of patients with chronic kidney disease and end‐stage renal disease.Seminars in Dialysis, 31(2), 115-121. Web.

Brauer, A., Waheed, S., Singh, T., & Maursetter, L. (2019). Improvement in hyperphosphatemia using phosphate education and planning talks.Journal of Renal Nutrition, 29(2), 156-162. Web.

CDC. (2021). Chronic Kidney Disease in the United States, 2021. cdc.gov. Web.

Chan, M. W., Cheah, H. M., & Mohd Padzil, M. B. (2019). Multidisciplinary education approach to optimize phosphate control among hemodialysis patients.International journal of clinical pharmacy, 41(5), 1282-1289. Web.

Dickerson, P. S. (2014). Needs assessment: Collecting the evidence.The Journal of Continuing Education in Nursing, 45(3), 104-105. Web.

Forfang, D., Edwards, D. P., & Kalantar-Zadeh, K. (2022). The impact of phosphorus management today on the quality of life: Patient perspectives. Kidney Medicine, 4(4), 100437. Web.

Hsu, H. T., Chiang, Y. C., Lai, Y. H., Lin, L. Y., Hsieh, H. F., & Chen, J. L. (2021). Effectiveness of multidisciplinary care for chronic kidney disease: A systematic review. Worldviews on Evidence‐Based Nursing, 18(1), 33-41. Web.

Karavetian, M., & Rizk, R. (2018). Patient education for hyperphosphatemia management: Improving outcomes while decreasing costs?Kidney Research and Clinical Practice, 37(1), 4. Web.

Milazi, M., Bonner, A., & Douglas, C. (2017). Effectiveness of educational or behavioral interventions on adherence to phosphate control in adults receiving hemodialysis: A systematic review.JBI Evidence Synthesis, 15(4), 971-1010. Web.

Oquendo, L. G., Asencio, J. M. M., & de Las Nieves, C. B. (2017). Contributing factors for therapeutic diet adherence in patients receiving hemodialysis treatment: An integrative review.Journal of Clinical Nursing, 26(23-24), 3893-3905. Web.

Pafili, Z., Maridaki, M., Giannaki, C. D., Karatzaferi, C., Liakopoulos, V., Eleftheriadis, T., & Sakkas, G. K. (2019). Phosphorus nutritional knowledge among dialysis health care providers and patients: A multicenter observational study.Clinical nutrition ESPEN, 31, 33-37. Web.

Pereira, R. A., Alvarenga, M. S., Avesani, C. M., & Cuppari, L. (2021). Strategies designed to increase the motivation for and adherence to dietary recommendations in patients with chronic kidney disease.Nephrology Dialysis Transplantation, 36(12), 2173-2181. Web.

Somuah, L. A. (2018). Educating Primary Care Nurses on Phosphorus Management in Chronic Kidney Disease Patients. Web.

Shivaprasad, S., Mateti, U. V., Shenoy, P., Shastry, C. S., & Dharmagadda, S. (2021). Clinical pharmacists’ scope of knowledge for medication therapy management in chronic kidney disease patients.Pharmacy Education, 21, 781-788. Web.

Teong, L. F., Khor, B. H., Radion Purba, K., Gafor, A. H. A., Goh, B. L., Bee, B. C., & Karupaiah, T. (2022). A Mobile app for triangulating strategies in phosphate education targeting patients with chronic kidney disease in Malaysia: Development, validation, and patient acceptance.Healthcare. 10(3), 535. Web.

Umeukeje, E. M., Mixon, A. S., & Cavanaugh, K. L. (2018). Phosphate-control adherence in hemodialysis patients: Current perspectives.Patient Preference and Adherence, 12, 1175. Web.

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