title: Management of hyperphosphataemia: practices and perspectives amongst the renal care community.
abstract: BACKGROUND
  Protein-rich foods are a major source of dietary phosphorus; therefore, helping patients to increase their dietary protein intake, while simultaneously managing their hyperphosphataemia, poses a significant challenge for renal care professionals.
  
  
  OBJECTIVE
  To examine the clinical recommendations and practice perceptions of renal care professionals providing nutrition and phosphate control advice to patients with chronic kidney disease (CKD).
  
  
  METHODS
  Renal care professionals from four European countries completed an online survey on the clinical management of hyperphosphataemia.
  
  
  RESULTS
  The majority of responders recommended a protein intake of less than 1.0 g/kg/day for pre-dialysis patients, 1.2 g/kg/day for patients undergoing peritoneal dialysis (PD) and 1.1-1.2 g/kg/day for patients undergoing haemodialysis (HD). The most common perception was that maintaining dietary protein intake and reducing dietary phosphorus intake are equally important for hyperphosphataemia management. For patients in the pre-dialysis stage, the majority of responders (59%) reported that their first-line management recommendation would be reduction of dietary phosphorus. For patients undergoing PD and HD, the majority of responders (53% and 59%, respectively) reported a first-line management recommendation of both reduction of dietary phosphorus and phosphate binder therapy. More renal nurses than dietitians perceived reducing dietary phosphorus to be more important than maintaining protein intake (for patients undergoing PD, 23% vs. 0%, respectively; for patients undergoing HD, 34% vs. 0%, respectively).
  
  
  CONCLUSIONS
  This renal care community followed professionally accepted guidelines for patient nutrition and management of hyperphosphataemia. There was disparity in the perceptions and recommendations between nurses and dietitians, highlighting the need to standardise management practices amongst renal care professionals.
authors.affiliation: Dialyse Centrum Groningen, Groningen, The Netherlands.
authors.forename: Christina Johanna Maria
authors.initials: CJ
authors.lastname: Nagel
authors.forename: María Cruz
authors.initials: MC
authors.lastname: Casal
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lindley
authors.forename: Susan
authors.initials: S
authors.lastname: Rogers
authors.forename: Jitka
authors.initials: J
authors.lastname: Pancířová
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kernc
authors.forename: J Brian
authors.initials: JB
authors.lastname: Copley
authors.forename: Denis
authors.initials: D
authors.lastname: Fouque
mesh_terms: D002614:Chelating Agents / Q000627:therapeutic use; D003299:Cooperative Behavior; D004044:Dietary Proteins / Q000008:administration & dosage* / Q000009:adverse effects*; D005060:Europe; D019983:Guideline Adherence; D006801:Humans; D054559:Hyperphosphatemia / Q000175:diagnosis / Q000178:diet therapy / Q000209:etiology / Q000451:nursing*; D033183:Interdisciplinary Communication; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000178:diet therapy / Q000451:nursing*; D010353:Patient Education as Topic; D010530:Peritoneal Dialysis / Q000451:nursing*; D016226:Phosphorus, Dietary / Q000008:administration & dosage* / Q000009:adverse effects*; D006435:Renal Dialysis / Q000451:nursing*; D011795:Surveys and Questionnaires
chemical_list: D002614:Chelating Agents; D004044:Dietary Proteins; D016226:Phosphorus, Dietary
keywords: Chronic kidney disease; Haemodialysis; Nursing; Nutrition/malnutrition; Peritoneal dialysis