title: Results of a pilot program to improve phosphorus outcomes in hemodialysis patients.
abstract: OBJECTIVE
  End-stage renal disease causes dysregulation of bone and mineral metabolism, including increased serum phosphorus levels. Kidney Foundation Kidney Disease Outcome Quality Initiative 2003 guidelines recommend maintaining phosphorus levels between 3.5 and 5.5 mg/dL in dialysis patients. We examined the effects of a focused phosphorus management pilot program designed to improve the percentage of hemodialysis patients achieving phosphorus levels <5.5 mg/dL. DESIGN, SETTING, SUBJECTS, AND INTERVENTION: We conducted a prospective, multicenter, single-arm study at 8 geographically diverse at-risk facilities (n = 702 hemodialysis patients) in a large U.S. dialysis organization. The focused phosphorus management program provided in-service training to staff members, and provided patients with diet and phosphorus management through in-center, 1:1 education and support, direct-to-patient adherence communications, benefit management assistance, and adherence support specific to lanthanum carbonate over a 6-month period.
  
  
  METHODS
  Facility-level markers of bone and mineral metabolism (phosphorus, parathyroid hormone, corrected calcium) and nutritional status (serum albumin, normalized protein catabolic rate) were assessed before and after program implementation.
  
  
  RESULTS
  There was a significant increase in the percentage of patients per facility achieving phosphorus levels <5.5 mg/dL (mean ± SD at baseline = 61.6% ± 5.2%; month 6 = 71.3% ± 9.0%; P < .01) and parathyroid hormone (150 to 300 pg/mL; mean ± SD at baseline = 39.1% ± 2.4%; month 6 = 44.5% ± 7.0%; P = .04). During the course of the evaluation, mean calcium, albumin, and normalized protein catabolic rate levels did not change significantly.
  
  
  CONCLUSIONS
  These results show proof-of-concept that a focused phosphorus management program targeting both staff members and patients can significantly improve patient outcomes without compromising nutritional status.
authors: DaVita Clinical Research, Minneapolis, Minnesota, USA. tracy.mayne@davita.com
authors: Tracy J
authors: TJ
authors: Mayne
authors: Debbie
authors: D
authors: Benner
authors: Kathy
authors: K
authors: Ricketts
authors: Mary
authors: M
authors: Burgess
authors: Steve
authors: S
authors: Wilson
authors: Lynne
authors: L
authors: Poole
authors: Michael
authors: M
authors: Smyth
authors: Carey
authors: C
authors: Colson
authors: Mahesh
authors: M
authors: Krishnan
mesh_terms: D000368:Aged; D001842:Bone and Bones / Q000378:metabolism; D002118:Calcium / Q000097:blood; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D007811:Lanthanum / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D008903:Minerals / Q000378:metabolism; D009752:Nutritional Status; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood*; D010865:Pilot Projects; D011446:Prospective Studies; D006435:Renal Dialysis; D012709:Serum Albumin / Q000032:analysis
chemical_list: D008903:Minerals; D010281:Parathyroid Hormone; D012709:Serum Albumin; D010758:Phosphorus; C119467:lanthanum carbonate; D007811:Lanthanum; D002118:Calcium