title: Managing serum phosphate in haemodialysis patients: time for an innovative approach?
abstract: OBJECTIVE
  Hyperphosphataemia, a common biochemical abnormality in chronic kidney disease, poses significant management challenges. This study aims to determine whether the reasons for this are multifactorial; including poor dietary knowledge, poor adherence to a low phosphate diet and phosphate-binding medications and the impact of age on these parameters.
  
  
  METHODS
  In order to compare serum phosphate and other associated parameters to the UK Renal Association Clinical Practice Guidelines 2010 an audit and service evaluation questionnaire was carried out in May 2011 on 130 haemodialysis outpatients attending the Plymouth Dialysis Unit.
  
  
  RESULTS
  Fifty-three percent of patients had serum phosphate within the target range of 1.1-1.7 mmol/l, 77% and 85% had serum calcium and parathyroid hormone within target ranges, respectively. Younger patients (18-45 years) were significantly less likely to have serum phosphate within range χ(2) (2, n=124)=18.77, P<0.001. Despite better knowledge of their own phosphate levels (P=0.005), phosphorus-rich foods (P<0.001), symptoms of hyperphosphataemia (P<0.001) and increased use of Renal Patient View (P=0.002), <65 years old had significantly higher phosphate levels than those >65 years (P<0.001). No significant associations were found between phosphate control and the following factors: gender, timing of dialysis shift, years on dialysis or dialysis adequacy.
  
  
  CONCLUSIONS
  In this population, despite better knowledge, younger patients have worse phosphate control than older patients. Using the same dietary education techniques may not be suitable for all ages, more innovative approaches supported by skilled health professionals are needed to motivate and engage with younger patients to promote self-management and adherence.
authors.affiliation: School of Health Professions, Plymouth University, PAHC, Plymouth, UK.
authors.forename: A
authors.initials: A
authors.lastname: Collinson
authors.affiliation: School of Health Professions, Plymouth University, PAHC, Plymouth, UK.
authors.forename: M
authors.initials: M
authors.lastname: McMullan
authors.affiliation: Department of Nephrology, Derriford Hospital, Plymouth, UK.
authors.forename: W Y
authors.initials: WY
authors.lastname: Tse
authors.affiliation: Department of Nephrology, Derriford Hospital, Plymouth, UK.
authors.forename: H
authors.initials: H
authors.lastname: Sadler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood; D005260:Female; D006801:Humans; D054559:Hyperphosphatemia / Q000097:blood / Q000150:complications / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000008:administration & dosage* / Q000097:blood*; D010758:Phosphorus / Q000008:administration & dosage / Q000032:analysis; D006435:Renal Dialysis; D011795:Surveys and Questionnaires; D006113:United Kingdom; D055815:Young Adult
chemical_list: D010281:Parathyroid Hormone; D010710:Phosphates; D010758:Phosphorus; D002118:Calcium