scholarly journals Sucroferric Oxyhydroxide as Part of Combination Phosphate Binder Therapy among Hemodialysis Patients

Kidney360 ◽  
2020 ◽  
Vol 1 (4) ◽  
pp. 263-272 ◽  
Author(s):  
Donald A. Molony ◽  
Vidhya Parameswaran ◽  
Linda H. Ficociello ◽  
Claudy Mullon ◽  
Robert J. Kossmann
Keyword(s):  
Combination Therapy ◽  
Phosphate Binder ◽  
Elevated Serum ◽  
Study Patient ◽  
Phosphate Binders ◽  
Maintenance Hemodialysis ◽  
Pill Burden ◽  
Disease Outcomes ◽  
Continued Use

BackgroundCombination therapy with multiple phosphate binders is prescribed to reduce elevated serum phosphorus (sP) concentrations among patients on maintenance hemodialysis. Sucroferric oxyhydroxide (SO), an iron-based phosphate binder, has demonstrated efficacy at reducing sP while also being associated with a low pill burden. Whereas the effects of SO monotherapy have been well characterized in clinical trials and observational cohorts, little is known about the effects of SO-containing combination therapy.MethodsPatients on hemodialysis (N=234) at Fresenius Kidney Care (FKC) who received ≥120 days of uninterrupted phosphate binder combination therapy with SO were included in this retrospective study. Patient data were censored after SO discontinuation, end of care at FKC, or completion of 12 months of follow-up. Quarterly (Q) changes in phosphate binder pill burden, mean sP, and proportion of patients achieving National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-KDOQI)–recommended sP levels (≤5.5 mg/dl) were compared between baseline (−Q1) and follow-up (Q1–Q4).ResultsPhosphate binder combination therapy with SO was associated with significant increase in the proportion of patients with sP ≤5.5 mg/dl (from 19% at baseline to up to 40% at follow-up; P<0.001) and reduction in sP at all postbaseline time points (from 6.7 mg/dl to 6.2–6.3 mg/dl; P<0.001). Patients on calcium acetate (N=54) and sevelamer (N=94) who added SO therapy at follow-up resulted in a ≥250% increase in patients achieving sP ≤5.5 mg/dl (all P<0.001). Whereas mean phosphate binder pill burden increased with initiation of phosphate binder combination therapy with SO (15.8 pills/d at Q1 versus 12.3 pills/d at −Q1), continued use of SO was associated with down-titration of non-SO phosphate binders such that, by Q4, mean total PB pill burden reduced to 12.3 pills/d.ConclusionsFor patients on hemodialysis with uncontrolled hyperphosphatemia, combination therapy with SO may allow for sustained improvements in sP control without adversely affecting phosphate binder pill burden.

scholarly journals Changes in serum albumin and other nutritional markers when using sucroferric oxyhydroxide as phosphate binder among hemodialysis patients: a historical cohort study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Kamyar Kalantar-Zadeh ◽  
Linda H. Ficociello ◽  
Vidhya Parameswaran ◽  
Nicolaos V. Athienites ◽  
Claudy Mullon ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Dietary Intake ◽  
Phosphate Binder ◽  
Clinical Care ◽  
Elevated Serum ◽  
Hemodialysis Patients ◽  
Serum Phosphorus ◽  
Pill Burden ◽  
Historical Cohort ◽  
Phosphorus Levels

Abstract Background Elevated serum phosphorus concentrations are common among maintenance hemodialysis patients. Protein is a major source of dietary phosphate, but restriction of protein intake can result in hypoalbuminemia and protein-energy wasting. We hypothesized that sucroferric oxyhydroxide (SO), a potent phosphate binder with a low pill burden, may reduce serum phosphorus levels in hemodialysis patients with hypoalbuminemia without adversely impacting albumin levels or dietary intake of protein. Methods We retrospectively examined de-identified data from 79 adult, in-center hemodialysis patients with baseline hypoalbuminemia (≤ 3.5 g/dL) switched to SO as part of routine clinical care for at least 1 year. Temporal changes (3-month intervals from baseline through Q4) in phosphate binder pill burden, serum phosphorous levels, nutritional markers, and equilibrated Kt/V were analyzed. Data from a matched reference group of non-hypoalbuminemic patients (N = 79) switched to SO were also examined. Results SO therapy was associated with a mean reduction of 45.7 and 45.1% in daily phosphate binder pill burden, and a mean reduction of 0.4 mg/dL and 0.51 mg/dL in serum phosphorus levels for the hypoalbuminemic and non-hypoalbuminemic patients, respectively. Hypoalbuminemic patients demonstrated significant increases in mean serum albumin levels from 3.50 mg/dL at baseline to 3.69, 3.74, 3.70, and 3.69 mg/dL during Q1 through Q4, respectively (P < 0.0001), whereas serum albumin levels remained unchanged in the non-hypoalbuminemic group. Conclusions Both hypoalbuminemic and non-hypoalbuminemic patients switching to SO exhibited significant reductions in serum phosphorus concentrations and daily phosphate binder pill burden. Among hypoalbuminemic patients, the initiation of SO therapy was also associated with increases in serum albumin, suggesting therapy may have allowed patients to increase their dietary intake of protein.

scholarly journals Effectiveness of sucroferric oxyhydroxide in patients on on-line hemodiafiltration in real-world clinical practice: A retrospective study

2019 ◽  
Vol 41 (2) ◽  
pp. 224-230
Author(s):  
Aníbal Ferreira ◽  
Bruno Pinto ◽  
David Navarro ◽  
João Aniceto ◽  
Pedro L Neves ◽  
...  
Keyword(s):  
Real World ◽  
Intravenous Iron ◽  
Routine Care ◽  
Serum Phosphorus ◽  
Phosphate Binders ◽  
Pill Burden ◽  
Increased Risk ◽  
On Line ◽  
Phosphorus Levels

Abstract Introduction: Hyperphosphatemia is a serious consequence of chronic kidney disease and has been associated with an increased risk for cardiovascular disease. Controlling serum phosphorus levels in patients on dialysis is a challenge for the clinicians and implies, in most cases, the use of phosphate binders (PB). Part of the reason for this challenge is poor adherence to treatment because of the high pill burden in this patient group. Objective: To assess the real-world effectiveness of sucroferric oxyhydroxide (SO) in controlling serum phosphorus levels and determine the associated pill burden. Methods: A multicenter, quantitative, retrospective, before-after study was conducted with patients receiving online hemodiafiltration. Patients who switched to SO as a part of routine care were included in the study. PB treatment, number of pills, serum phosphorus levels, and intravenous iron medication and dosage were collected monthly during the six months of treatment with either PB or SO. Results: A total of 42 patients were included in the study. After switching from a PB to SO, the prescribed pills/day was reduced 67% from 6 pills/day to 2 pills/day (p < 0.001) and the frequency of pill intake was lowered from 3 times/day to 2 times/day (p < 0.001). During the treatment with SO, the proportion of patients with serum phosphorus ≤ 5.5 mg/dL increased from 33.3% at baseline to 45% after six months of treatment. Conclusion: During the six-month follow-up with SO, serum phosphorus levels were controlled with one third of the pills/day compared to other PB.

scholarly journals Changes in serum albumin and other nutritional markers when using sucroferric oxyhydroxide as phosphorus binder among hemodialysis patients: a historical cohort study

2019 ◽  
Author(s):  
Kamyar Kalantar-Zadeh ◽  
Linda H Ficociello ◽  
Vidhya Parameswaran ◽  
Nicolaos V. Athienites ◽  
Claudy Mullon ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Dietary Intake ◽  
Phosphate Binder ◽  
Clinical Care ◽  
Elevated Serum ◽  
Hemodialysis Patients ◽  
Serum Phosphorus ◽  
Pill Burden ◽  
Historical Cohort ◽  
Phosphorus Levels

Abstract Background Elevated serum phosphorus concentrations are common among maintenance hemodialysis patients. Protein is a major source of dietary phosphate, but restriction of protein intake can result in hypoalbuminemia and protein-energy wasting. We hypothesized that sucroferric oxyhydroxide (SO), a potent phosphate binder with a low pill burden, may reduce serum phosphorus levels in hemodialysis patients with hypoalbuminemia without adversely impacting albumin levels or dietary intake of protein.Methods We retrospectively examined de-identified data from 79 adult, in-center hemodialysis patients with baseline hypoalbuminemia (≤ 3.5 g/dL) switched to SO as part of routine clinical care for at least 1 year. Temporal changes (3-month intervals from baseline through Q4) in phosphate binder pill burden, serum phosphorous levels, nutritional markers, and equilibrated Kt/V were analyzed. Data from a matched reference group of non-hypoalbuminemic patients ( N = 79) switched to SO were also examined.Results SO therapy was associated with a mean reduction of 45.7% and 45.1% in daily phosphate binder pill burden, and a mean reduction of 0.4 mg/dL and 0.51 mg/dL in serum phosphorus levels for the hypoalbuminemic and non-hypoalbuminemic patients, respectively. Hypoalbuminemic patients demonstrated significant increases in mean serum albumin levels from 3.50 mg/dL at baseline to 3.69, 3.74, 3.70, and 3.69 mg/dL during Q1 through Q4, respectively ( P < 0.0001), whereas serum albumin levels remained unchanged in the non-hypoalbuminemic group.Conclusions Both hypoalbuminemic and non-hypoalbuminemic patients switching to SO exhibited significant reductions in serum phosphorus concentrations and daily phosphate binder pill burden. Among hypoalbuminemic patients, the initiation of SO therapy was also associated with increases in serum albumin, suggesting therapy may have allowed patients to increase their dietary intake of protein.

Risk Factors for Hyperaluminemia in Continuous Ambulatory Peritoneal Dialysis

1986 ◽  
Vol 6 (4) ◽  
pp. 188-191 ◽  
Author(s):  
Robert A. Mactier ◽  
Karl D. Nolph ◽  
Ramesh Khanna ◽  
Zbylut Twardowski
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Aluminum Toxicity ◽  
Elevated Serum ◽  
Phosphate Binders ◽  
Untreated Water ◽  
Stage Renal Disease ◽  
End Stage

The authors evaluated risk factors for hyperaluminemia and aluminum toxicity in 51 CAPD patients, who received aluminum-containing phosphate binders. Serum aluminum correlated with total intake of elemental aluminum after starting CAPD (p = 0.001), with aluminum intake in the previous six months (p = 0.001), with duration of CAPD (p = 0.003), and with serum phosphate (p = 0.05). Eight patients had elevated serum aluminum, but only one had clincial evidence of aluminum toxicity (he had been on hemodialysis with untreated water until he was changed to CAPD 30 months before the study). Although the incidence of clinical aluminum toxicity appears to be low, we conclude that the aluminum intake from aluminum-containing phosphate binders is a major factor in the evolution of hyperaluminemia and, potentially, aluminum toxicity in CAPD patients. We believe that alternative effective, phosphate binders are much needed. It has been shown that tissue accumulation of aluminum in brain, bone and blood in uremic patients causes encephalopathy (I. 2), osteomalacia (3, 4), and anemia (5, 6). Clinically aluminum toxicity has been observed mainly in hemodialysis patients (1–6), although it has been reported in few cases before dialysis (7–9) and in those on continuous ambulatory peritoneal dialysis (10. II). The major cause of aluminum toxicity during hemodialysis has been transfer of aluminum from untreated water in the dialysate (1–5); this mechanism has tended to obscure the contribution of other factors, such as diet and drugs. Peritoneal dialysate contains a low concentration of aluminum (less than 15 μg/L) and there is a net removal of aluminum in the dialysate in those with serum aluminum levels within the reference range for dialysed uremics (11–13). Serial aluminum levels in CAPD patients not receiving aluminum -containing phosphate binders (ACPB) showed no significant change during a two-year follow-up (12, 14); this suggests that aluminum removal in the dialysate compensates for the failure of the kidney to excrete absorbed dietary aluminum in end-stage renal disease. Since the combination of CAPD and diet appears to have minimal influence on serum aluminum, this study was done to identify those factors which determine serum aluminum levels in CAPD patients, receiving aluminum-containing phosphate binders.

scholarly journals Changes in serum albumin and other nutritional markers when using sucroferric oxyhydroxide as phosphorus binder among hemodialysis patients: a historical cohort study

2019 ◽  
Author(s):  
Kamyar Kalantar-Zadeh ◽  
Linda H Ficociello ◽  
Vidhya Parameswaran ◽  
Nicolaos V. Athienites ◽  
Claudy Mullon ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Dietary Intake ◽  
Phosphate Binder ◽  
Clinical Care ◽  
Elevated Serum ◽  
Hemodialysis Patients ◽  
Serum Phosphorus ◽  
Pill Burden ◽  
Historical Cohort ◽  
Phosphorus Levels

Abstract Background Elevated serum phosphorus concentrations are common among maintenance hemodialysis patients. Protein is a major source of dietary phosphate, but restriction of protein intake can result in hypoalbuminemia and protein-energy wasting. We hypothesized that sucroferric oxyhydroxide (SO), a potent phosphate binder with a low pill burden, may reduce serum phosphorus levels in hemodialysis patients with hypoalbuminemia without adversely impacting albumin levels or dietary intake of protein.Methods We retrospectively examined de-identified data from 79 adult, in-center hemodialysis patients with baseline hypoalbuminemia (≤ 3.5 g/dL) switched to SO as part of routine clinical care for at least 1 year. Temporal changes (3-month intervals from baseline through Q4) in phosphate binder pill burden, serum phosphorous levels, nutritional markers, and equilibrated Kt/V were analyzed. Data from a matched reference group of non-hypoalbuminemic patients ( N = 79) switched to SO were also examined.Results SO therapy was associated with a mean reduction of 45.7% and 45.1% in daily phosphate binder pill burden, and a mean reduction of 0.4 mg/dL and 0.51 mg/dL in serum phosphorus levels for the hypoalbuminemic and non-hypoalbuminemic patients, respectively. Hypoalbuminemic patients demonstrated significant increases in mean serum albumin levels from 3.50 mg/dL at baseline to 3.69, 3.74, 3.70, and 3.69 mg/dL during Q1 through Q4, respectively ( P < 0.0001), whereas serum albumin levels remained unchanged in the non-hypoalbuminemic group.Conclusions Both hypoalbuminemic and non-hypoalbuminemic patients switching to SO exhibited significant reductions in serum phosphorus concentrations and daily phosphate binder pill burden. Among hypoalbuminemic patients, the initiation of SO therapy was also associated with increases in serum albumin, suggesting therapy may have allowed patients to increase their dietary intake of protein.

scholarly journals Changes in serum albumin and other nutritional markers when using sucroferric oxyhydroxide as phosphorus binder among hemodialysis patients: a historical cohort study

2019 ◽  
Author(s):  
Kamyar Kalantar-Zadeh ◽  
Linda H Ficociello ◽  
Vidhya Parameswaran ◽  
Nicolaos V. Athienites ◽  
Claudy Mullon ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Dietary Intake ◽  
Phosphate Binder ◽  
Clinical Care ◽  
Elevated Serum ◽  
Hemodialysis Patients ◽  
Serum Phosphorus ◽  
Pill Burden ◽  
Historical Cohort ◽  
Phosphorus Levels

Abstract Background Elevated serum phosphorus concentrations are common among maintenance hemodialysis patients. Protein is a major source of dietary phosphate, but restriction of protein intake can result in hypoalbuminemia and protein-energy wasting. We hypothesized that sucroferric oxyhydroxide (SO), a potent phosphate binder with a low pill burden, may reduce serum phosphorus levels in hemodialysis patients with hypoalbuminemia without adversely impacting albumin levels or dietary intake of protein.Methods We retrospectively examined de-identified data from 79 adult, in-center hemodialysis patients with baseline hypoalbuminemia (≤ 3.5 g/dL) switched to SO as part of routine clinical care for at least 1 year. Temporal changes (3-month intervals from baseline through Q4) in phosphate binder pill burden, serum phosphorous levels, nutritional markers, and equilibrated Kt/V were analyzed. Data from a matched reference group of non-hypoalbuminemic patients ( N = 79) switched to SO were also examined.Results SO therapy was associated with a mean reduction of 45.7% and 45.1% in daily phosphate binder pill burden, and a mean reduction of 0.4 mg/dL and 0.51 mg/dL in serum phosphorus levels for the hypoalbuminemic and non-hypoalbuminemic patients, respectively. Hypoalbuminemic patients demonstrated significant increases in mean serum albumin levels from 3.50 mg/dL at baseline to 3.69, 3.74, 3.70, and 3.69 mg/dL during Q1 through Q4, respectively ( P < 0.0001), whereas serum albumin levels remained unchanged in the non-hypoalbuminemic group.Conclusions Both hypoalbuminemic and non-hypoalbuminemic patients switching to SO exhibited significant reductions in serum phosphorus concentrations and daily phosphate binder pill burden. Among hypoalbuminemic patients, the initiation of SO therapy was also associated with increases in serum albumin, suggesting therapy may have allowed patients to increase their dietary intake of protein.

scholarly journals Effects of Sucroferric Oxyhydroxide Compared to Lanthanum Carbonate and Sevelamer Carbonate on Phosphate Homeostasis and Vascular Calcifications in a Rat Model of Chronic Kidney Failure

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Olivier Phan ◽  
Marc Maillard ◽  
Hartmut H. Malluche ◽  
Jean-Christophe Stehle ◽  
Felix Funk ◽  
...  
Keyword(s):  
Phosphate Binder ◽  
Chronic Renal Disease ◽  
Fibroblast Growth Factor 23 ◽  
Elevated Serum ◽  
Chronic Kidney Failure ◽  
Lanthanum Carbonate ◽  
Phosphate Binders ◽  
Vascular Calcifications ◽  
Serum Ipth ◽  
Sevelamer Carbonate

Elevated serum phosphorus, calcium, and fibroblast growth factor 23 (FGF23) levels are associated with cardiovascular disease in chronic renal disease. This study evaluated the effects of sucroferric oxyhydroxide (PA21), a new iron-based phosphate binder, versus lanthanum carbonate (La) and sevelamer carbonate (Se), on serum FGF23, phosphorus, calcium, and intact parathyroid hormone (iPTH) concentrations, and the development of vascular calcification in adenine-induced chronic renal failure (CRF) rats. After induction of CRF, renal function was significantly impaired in all groups: uremic rats developed severe hyperphosphatemia, and serum iPTH increased significantly. All uremic rats (except controls) then received phosphate binders for 4 weeks. Hyperphosphatemia and increased serum iPTH were controlled to a similar extent in all phosphate binder-treatment groups. Only sucroferric oxyhydroxide was associated with significantly decreased FGF23. Vascular calcifications of the thoracic aorta were decreased by all three phosphate binders. Calcifications were better prevented at the superior part of the thoracic and abdominal aorta in the PA21 treated rats. In adenine-induced CRF rats, sucroferric oxyhydroxide was as effective as La and Se in controlling hyperphosphatemia, secondary hyperparathyroidism, and vascular calcifications. The role of FGF23 in calcification remains to be confirmed.

Serum Thyroid Peroxidase Antibody Level and Incident Hypertension in Iranian Men: A Suggestion for the Role of Thyroid Autoimmunity

2020 ◽  
Vol 20 (10) ◽  
pp. 1711-1718
Author(s):  
Maryam Tohidi ◽  
Aidin Baghbani-Oskouei ◽  
Atieh Amouzegar ◽  
Ladan Mehran ◽  
Fereidoun Azizi ◽  
...  
Keyword(s):  
Total Population ◽  
Thyroid Autoimmunity ◽  
Elevated Serum ◽  
Thyroid Peroxidase ◽  
Incident Hypertension ◽  
Natural Logarithm ◽  
Hazard Ratios ◽  
Thyroid Peroxidase Antibody ◽  
Unit Increase

Background: Dysfunction of the thyroid gland has profound effects on the cardiovascular system. Objective: We aimed to explore the relation of serum thyroid peroxidase antibody (TPO-Ab), as a marker of thyroid autoimmunity with incident hypertension among a euthyroid population. Methods: A total of 3681 participants (1647 men) entered the study. Multivariate Cox proportional hazard models were conducted to estimate the association between TPO-Ab and incident hypertension. Results: The mean age (standard deviation) of the participants was 37.5 (12.8) years. During a median follow-up of 12.2 years, 511 men and 519 women developed hypertension. The multivariable hazard ratios (HRs) and related 95% confidence intervals (CIs) of 1-unit increase in natural logarithm (ln) of TPO-Ab for incident hypertension were 1.09 (1.00-1.19), 1.03 (0.97-1.10), and 1.05 (1.00-1.11) for men, women, and total population, respectively. Moreover, considering the TPO-Ab status as a categorical variable (i.e. TPO-Ab positive or TPO-Ab negative), the multivariate-adjusted HRs (95% CIs) of TPO-Ab positivity for incident hypertension, were 1.33 (0.95-1.85), 1.12 (0.86-1.45) and 1.19 (0.97- 1.46) for men, women, and total population, respectively. Conclusion: Elevated serum TPO-Ab level can contribute to the development of hypertension among euthyroid men during a long follow-up; suggesting a role for thyroid autoimmunity.

P084 DEEP REMISSION WITH DOUBLE BIOLOGIC THERAPY: A SUCCESSFUL CASE OF COMBINATION USTEKINUMAB AND VEDOLIZUMAB FOR SEVERE REFRACTORY CROHN’S DISEASE

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S72-S72
Author(s):  
Ahmed Elmoursi ◽  
Courtney Perry ◽  
Terrence Barrett
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Combination Therapy ◽  
Clinical Remission ◽  
Biologic Therapy ◽  
Case Reports ◽  
Sigmoid Resection ◽  
Safety And Efficacy ◽  
Ileal Stricture

Abstract Background Stricturing Crohn’s disease (CD) constitutes a severe phenotype often associated with a high degree of morbidity (3). Surgical resection is first-line therapy for symptomatic strictures, but most patients relapse without subsequent medical therapy (4–5). Biologics are the mainstay for inducing and maintaining remission, but some cases are refractory despite maximum dosage of therapy. Reports of dual biological therapy (DBT) in refractory, stricturing CD are sparse, and prior case reports document only clinical remission (1). To contribute further knowledge regarding the use of DBT in stricturing CD, we present the case of a refractory CD patient who achieved deep remission with ustekinumab and vedolizumab. Case Presentation A 35 year old non-smoking, Caucasian male was referred to our clinic in 2014 for refractory CD complicated by multiple strictures. Prior to establishing care with us, he received two jejunal resections and a sigmoid resection. Previously failed therapies included azathioprine with infliximab, adalimumab, and certolizumab. He continued to progress under our care despite combination methotrexate/certolizumab, as well as methotrexate/golimumab. He underwent proctocolectomy with end ileostomy in 2015 and initiated vedolizumab q8weeks post-operatively. He reoccurred in 2018, when he presented with an ulcerated ileal stricture. He was switched from vedolizumab to ustekinumab q8weeks and placed on prednisone, but continued to progress, developing significant hematochezia requiring hospitalization and blood transfusions. Ileoscopy performed during hospital admission confirmed severe, ulcerating disease in the ileum with stricture. Ustekinumab dosing was increased to q4weeks, azathioprine was initiated, and he underwent stricturoplasty. Follow-up ileoscopy three months later revealed two ulcers in the neo- TI (Figure 1). Vedolizumab q8weeks was initiated in addition to ustekinumab q4weeks and azathioprine 125mg. After four months on this regimen the patient felt better, but follow-up ileoscopy showed two persistent ulcers in the neo-TI. Vedolizumab dosing interval was increased to q4weeks. After four months, subsequent ileoscopy demonstrated normal neo-TI (Figure 2). Histologic evaluation of biopsies confirmed deep remission of crohn’s disease. No adverse side effects have occurred with maximum doses of both ustekinumab and vedolizumab combination therapy. Discussion This case supports both the safety and efficacy of ustekinumab and vedolizumab dual biologic therapy for treatment of severe, refractory Crohn’s disease. While there are reports of DBT inducing clinical remission, this case supports efficacy for vedolizumab and ustekinumab combination therapy to induce deep histologic remission. Large practical clinical trials are needed to better investigate the safety and efficacy of DBT with vedolizumab and ustekinumab, but our case suggests this combination may be a safe and efficacious therapy for refractory CD patients.

scholarly journals Implementation and effectiveness of an intensive education program on phosphate control among hemodialysis patients: a non-randomized, single-arm, single-center trial

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jinmei Yin ◽  
Jun Yin ◽  
Rongli Lian ◽  
Peiqiu Li ◽  
Jing Zheng
Keyword(s):  
Education Program ◽  
Hemodialysis Patients ◽  
Serum Phosphorus ◽  
Phosphate Binders ◽  
Maintenance Hemodialysis ◽  
Single Center ◽  
Clinical Trial Registry ◽  
Before And After ◽  
Intensive Education ◽  
Phosphate Control

Abstract Background Hyperphosphatemia is a common complication in patients on maintenance hemodialysis. Patients’ adherence to phosphorus control can be improved by consistent education. However, few studies have focused on the model construction and effects of health education on phosphate control for hemodialysis patients. Objective To develop an intensive education program focusing on phosphate control among hemodialysis patients and to analyze the effectiveness of this program. Design A non-randomized, single-arm, single-center trial lasting for 6 months. Setting This program was conducted in a hemodialysis center in a teaching hospital in Zhuhai, China. Participants Patients on maintenance hemodialysis with hyperphosphatemia. Methods An intensive hyperphosphatemia control education program lasting for 6 months was conducted among 366 hemodialysis patients applying the First Principles of Instruction model, which focused on mastering four stages: (a) activation of prior experience, (b) demonstration of skills, (c) application of skills and (d) integration of these skills into real-world activities. The controlled percentage of serum phosphorus, knowledge of hyperphosphatemia, and adherence to phosphate binders before and after the education program were assessed. Results The proportion of controlled serum phosphorus was significantly increased from 43.5 to 54.9% (P<0.001). The scores on the knowledge of phosphate control were improved significantly from 59.0 ± 18.9 to 80.6 ± 12.4 (P < 0.001). The proportion of high adherence to phosphate binders was increased dramatically from 21.9 to 44.5% (P < 0.001). Conclusion The intensive education program can effectively improve serum phosphorus, knowledge of hyperphosphatemia, and adherence to phosphate binders among hemodialysis patients. Trial registration Chinese Clinical Trial Registry, ChiCTR2100042017. Retrospectively registered January 12th, 2021.

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