title: Psychosocial Factors That Create Barriers to Managing Serum Phosphorus Levels in Pediatric Dialysis Patients: A Retrospective Analysis.
abstract: Abnormal phosphorus homeostasis is among the medley of metabolic disturbances commonly associated with chronic kidney disease. We sought to determine the psychosocial factors that create barriers to controlling serum phosphorus levels in children on dialysis and to evaluate the perceptions of children and caregivers on the ease or difficulty of following a dietary phosphorus restriction and taking phosphorus binder medications.
  
  
  
  Single center cross-sectional study.
  
  
  
  Pediatric dialysis unit at a children's hospital.
  
  
  
  Forty-eight patients on chronic hemodialysis or peritoneal dialysis (mean age: 11.03 ± 6.88 years; 69% male).
  
  
  
  Serum phosphorus levels were recorded from electronic health records and converted to a mean phosphorus standard deviation score (SDS) for each individual. Mean phosphorus SDS values were compared to each independent categorical variable using an analysis of variance test, continuous variables were analyzed using linear regression, and logistic regression was used to determine odds ratios.
  
  
  
  There was a significant relationship between age and phosphorus SDS (P < .001), with patients over 13 years of age having the highest prevalence of hyperphosphatemia (88%). Patients and caregivers who identified phosphorus levels as "controlled" had lower phosphorus SDS values compared to the other subjects (P = .003). However, of the patients and caregivers who reported that serum phosphorus levels were "controlled," 46% were hyperphosphatemic. Furthermore, 73% and 87% of patients and caregivers reported that following a phosphorus-restricted diet and taking phosphorus binders were "easy"; yet, 40% and 49% of these patients were hyperphosphatemic, respectively.
  
  
  
  In the present study, elevated serum phosphorus levels were most common in adolescent dialysis patients. There also appears to be a disconnect between the perceived ease of following a phosphorus-restricted diet and taking phosphorus binders and the achievement of normal serum phosphorus levels. These data further emphasize the importance of ongoing education regarding dietary and medical management requirements.
authors.affiliation: Department of Nutrition Services, Children's Mercy Hospital, Kansas City, Missouri 64108; KU Department of Dietetics & Nutrition, School of Health Professions, University of Kansas Medical Center, Kansas City, Kansas 66160. Electronic address: jacobtaylor.ms_rd@yahoo.com.
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Taylor
authors.affiliation: Department of Nutrition Services, Children's Mercy Hospital, Kansas City, Missouri 64108.
authors.forename: Leah
authors.initials: L
authors.lastname: Oladitan
authors.affiliation: Department of Social Work, Children's Mercy Hospital, Kansas City, Missouri 64108.
authors.forename: Angela
authors.initials: A
authors.lastname: Degnan
authors.affiliation: Department of Social Work, Children's Mercy Hospital, Kansas City, Missouri 64108.
authors.forename: Sarah
authors.initials: S
authors.lastname: Henderson
authors.affiliation: Department of Health Outcomes Research, Children's Mercy Hospital, Kansas City, Missouri 64108.
authors.forename: Hongying
authors.initials: H
authors.lastname: Dai
authors.affiliation: Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, Missouri 64108.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Warady
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004032:Diet; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D054559:Hyperphosphatemia / Q000097:blood / Q000209:etiology / Q000628:therapy; D008297:Male; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000523:psychology; D010758:Phosphorus / Q000097:blood*; D016226:Phosphorus, Dietary / Q000008:administration & dosage / Q000032:analysis; D006435:Renal Dialysis / Q000009:adverse effects / Q000523:psychology*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy; D012189:Retrospective Studies; D012959:Socioeconomic Factors
chemical_list: D016226:Phosphorus, Dietary; D010758:Phosphorus