EPIC Trial: education programme impact on serum phosphorous control in CKD 5D patients on hemodialysis

Abstract Introduction: In stage 5D chronic kidney disease (CKD 5D) patients, the encouragement of treatment adherence by health professionals is a significant clinical challenge. Objectives: This study evaluates the impact of a nutritional education programme on hyperphosphatemia, utilizing the transtheoretical model of behavior change (TMBC). Subjects and Methods: A prospective interventional study comprising 179 CKD 5D patients with hypophosphatemia. The 4-month educational programme took place during dialysis sessions. Demographic and laboratory data were evaluated, whilst the TMBC was utilized both pre- and post-intervention. Results: 132 patients showed a positive change and significant reduction in phosphate levels, whilst 47 patients showed a negative change and little reduction in phosphate levels. Positive changes were identified at different levels of literacy. 117/179 participants had ongoing treatment with sevelamer throughout the trial period. 61 patients with intact parathyroid hormone (iPTH) < 300pg/ml showed phosphate level reductions, whilst 118 patients with iPTH > 300 pg/ml also showed a decrease in phosphate levels. Conclusions: Nutritional education programmes can achieve excellent results when appropriately applied. An education programme may be effective across different literacy levels.

摘要
引言：对于5D期慢性肾脏病（CKD 5D）患者而言，促使其坚持治疗依从性是临床工作中的一项重大挑战。
研究目的：本研究借助行为改变跨理论模型（transtheoretical model of behavior change, TMBC），评估营养教育项目对高磷血症的干预效果。
研究对象与方法：本研究为一项前瞻性干预研究，共纳入179例合并低磷血症的CKD 5D患者。为期4个月的教育项目于透析治疗时段内开展。研究收集了受试者的人口统计学资料与实验室检测数据，并于干预前后均采用行为改变跨理论模型进行评估。
研究结果：132例患者的血磷水平显著下降且治疗行为呈积极改变，另有47例患者血磷水平降幅较小且治疗行为呈消极改变。不同文化程度的受试者均观察到积极变化。整个试验周期内，117/179例受试者持续服用司维拉姆（sevelamer）进行治疗。61例全段甲状旁腺激素（intact parathyroid hormone, iPTH）＜300pg/ml的患者血磷水平出现下降，118例iPTH＞300pg/ml的患者血磷水平同样有所降低。
研究结论：合理应用营养教育项目可取得优异的干预效果，且该教育项目对不同文化程度的人群均具备有效性。