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Abstract
Introduction: Phosphorus control in haemodialysis patients is very important for the prevention of complications.
Objective: To assess blood phosphorus levels before, during and after medical and nurse-medical interventions.
Material and Method: Quasi-experimental, analytical, longitudinal and prospective study in a population of hospital hemodialysis patients. The study lasted 18 months in which nurses and doctors monitored the prescription of phosphorus chelators during different months. Data on analytical results were collected The Morisky Green test was administered to assess adherence to treatment, as well as a checklist to assess the side effects of the chelators.
Results: A total of 19 patients were studied. The phosphorus levels (median; interquartile range) were: (4.8; 1.3) mg/dl in the previous period, (4.5; 1.9) mg/dl in the physician period and (4.5; 0.9 mg/dl) in the nurse-physician period. The results were compared between the different periods and no statistically significant differences were observed between the phosphorus levels. Nor were differences in these levels observed when separating compliant and non-compliant patients.
Conclusions: Although no significant differences were found, a decrease in phosphorus was observed with continuous dietary reinforcement by nurses. It is therefore concluded that nurses, together with medical support, could be involved in the monthly phosphorus prescription and control of the unit's patients.
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References
- Chamorro MÁ, García-Jiménez E, Amariles P, Chamorro AR, Merino EM, Martínez FM, Dader MJ. Efecto de la actuación farmacéutica en la adherencia del tratamiento farmacológico de pacientes ambulatorios con riesgo cardiovascular (Estudio EMDADER-CV-INCUMPLIMIENTO). Aten Primaria. 2011;43(5):245-53. DOI: https://doi.org/10.1016/j.aprim.2010.05.006
- Bover Sanjuán J, Navarro-González JF, Arenas MD, Torregrosa JV, Tamargo Menéndez J, de Francisco ALM, et al. Pharmacological interactions of phosphate binders. Nefrologia (Engl Ed). 2018;38(6):573-8. DOI: https://doi.org/10.1016/j.nefroe.2018.08.001
- Contreras F, Esguerra G, Espinosa J, Gutiérrez C, Fajardo L. Adhesión al tratamiento en pacientes con insuficiencia renal crónica en tratamiento de hemodiálisis. Univ. Psychol. Bogotá 2006;5(3):487-99.
- García-Llana H, Remor E, Selgas R. Adherence to treatment, emotional state and quality of life in patients with end stage renal disease undergoing dialysis. Psicothema 2013;25(1):79-86.
- Redondo Simón M C, Casuso Jiménez L, Martínez Jiménez I, Rodríguez Puertas J F, Palacios Gómez María E, Cara Sánchez E. La hiperfosfatemia en paciente renal en programa de hemodiálisis. Enferm Nefrol 2015; 18(supl 1):S124.
- Cheng TY, Tarng DC, Liao YM, Lin PC. Effects of systematic nursing instruction on a low-phosphorus diet, serum phosphorus level and pruritus of patients on haemodialysis. J Clin Nurs. 2017;26(3-4):485-94. DOI: https://doi.org/10.1111/jocn.13471
- Barril-Cuadrado G, Puchulu MB, Sánchez-Tomero JA. Tablas de ratio fósforo/proteína de alimentos para población española. Utilidad en la enfermedad renal crónica. Nefrologia. 2013;33(3):362-71.
- Cvengros JA, Christensen AJ, Lawton WJ. The role of perceived control and preference for control in adherence to a chronic medical regimen. Ann Dehav Med 2004;27(3):155-61. DOI: https://doi.org/10.1207/s15324796abm2703_3
- National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003; 42 (4 supl 3):S1-201. DOI: https://doi.org/10.1016/S0272-6386(03)00905-3
- Narita I, Alchi B, Omori K, Sato F, Ajiro J, Saga D, et al. Etiology and prognostic significance of severe uremic pruritus in chronic hemodialysis patients. Kidney Int. 2006;69(9):1626-32. DOI: https://doi.org/10.1038/sj.ki.5000251
- Torregrosa J-V, Bover J, Cannata Andía J, Lorenzo V, de Francisco ALM, Martínez I, et al. Spanish Society of Nephrology recommendations for controlling mineral and bone disorder in chronic kidney disease patients (SEN-MBD). Nefrologia. 2011;31 (supl 1):S3-32.
- Díaz Martínez MJ, González Suárez ME, González Suárez E, Fernández Merayo C. Efectividad de las intervenciones de enfermería en el control del fósforo. Enferm Nefrol. 2012;15(supl 1):S110.
- Ruiz García E, Latorre López LI, Delgado Ramírez A, Crespo Montero R, Sánchez Laguna JL. Adherencia al tratamiento farmacológico en pacientes en hemodiálisis. Enferm Nefrol. 2016;19(3):232-41. DOI: https://doi.org/10.4321/S2254-28842016000300005
- Hernández Moreno L, Perinango Romy J, Casanovas Izquierdo E. Influencia de la educación para el control del fósforo sérico realizada por enfermería a pacientes y a sus cuidadores principales. Enferm Nefrol. 2014;17(2):92-7. DOI: https://doi.org/10.4321/S2254-28842014000200002
- Neri L, Martini A, Andreucci VE, Gallieni M, Rey LA, Brancaccio D; MigliorDialisi Study Group. Regimen complexity and prescription adherence in dialysis patients. Am J Nephrol. 2011;34(1):71-6. DOI: https://doi.org/10.1159/000328391
- Arenas MD, Pérez-García R, Bennouna M, Blanco A, Mauricio Reatiga O, Prados MD et al. Mejoría del cumplimiento terapéutico en pacientes en hemodiálisis con mal control del fósforo y mala adherencia al tratamiento con captores: Estudio COMQUELFOS. Nefrología 2013;33(2):196-203.
References
Chamorro MÁ, García-Jiménez E, Amariles P, Chamorro AR, Merino EM, Martínez FM, Dader MJ. Efecto de la actuación farmacéutica en la adherencia del tratamiento farmacológico de pacientes ambulatorios con riesgo cardiovascular (Estudio EMDADER-CV-INCUMPLIMIENTO). Aten Primaria. 2011;43(5):245-53. DOI: https://doi.org/10.1016/j.aprim.2010.05.006
Bover Sanjuán J, Navarro-González JF, Arenas MD, Torregrosa JV, Tamargo Menéndez J, de Francisco ALM, et al. Pharmacological interactions of phosphate binders. Nefrologia (Engl Ed). 2018;38(6):573-8. DOI: https://doi.org/10.1016/j.nefroe.2018.08.001
Contreras F, Esguerra G, Espinosa J, Gutiérrez C, Fajardo L. Adhesión al tratamiento en pacientes con insuficiencia renal crónica en tratamiento de hemodiálisis. Univ. Psychol. Bogotá 2006;5(3):487-99.
García-Llana H, Remor E, Selgas R. Adherence to treatment, emotional state and quality of life in patients with end stage renal disease undergoing dialysis. Psicothema 2013;25(1):79-86.
Redondo Simón M C, Casuso Jiménez L, Martínez Jiménez I, Rodríguez Puertas J F, Palacios Gómez María E, Cara Sánchez E. La hiperfosfatemia en paciente renal en programa de hemodiálisis. Enferm Nefrol 2015; 18(supl 1):S124.
Cheng TY, Tarng DC, Liao YM, Lin PC. Effects of systematic nursing instruction on a low-phosphorus diet, serum phosphorus level and pruritus of patients on haemodialysis. J Clin Nurs. 2017;26(3-4):485-94. DOI: https://doi.org/10.1111/jocn.13471
Barril-Cuadrado G, Puchulu MB, Sánchez-Tomero JA. Tablas de ratio fósforo/proteína de alimentos para población española. Utilidad en la enfermedad renal crónica. Nefrologia. 2013;33(3):362-71.
Cvengros JA, Christensen AJ, Lawton WJ. The role of perceived control and preference for control in adherence to a chronic medical regimen. Ann Dehav Med 2004;27(3):155-61. DOI: https://doi.org/10.1207/s15324796abm2703_3
National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003; 42 (4 supl 3):S1-201. DOI: https://doi.org/10.1016/S0272-6386(03)00905-3
Narita I, Alchi B, Omori K, Sato F, Ajiro J, Saga D, et al. Etiology and prognostic significance of severe uremic pruritus in chronic hemodialysis patients. Kidney Int. 2006;69(9):1626-32. DOI: https://doi.org/10.1038/sj.ki.5000251
Torregrosa J-V, Bover J, Cannata Andía J, Lorenzo V, de Francisco ALM, Martínez I, et al. Spanish Society of Nephrology recommendations for controlling mineral and bone disorder in chronic kidney disease patients (SEN-MBD). Nefrologia. 2011;31 (supl 1):S3-32.
Díaz Martínez MJ, González Suárez ME, González Suárez E, Fernández Merayo C. Efectividad de las intervenciones de enfermería en el control del fósforo. Enferm Nefrol. 2012;15(supl 1):S110.
Ruiz García E, Latorre López LI, Delgado Ramírez A, Crespo Montero R, Sánchez Laguna JL. Adherencia al tratamiento farmacológico en pacientes en hemodiálisis. Enferm Nefrol. 2016;19(3):232-41. DOI: https://doi.org/10.4321/S2254-28842016000300005
Hernández Moreno L, Perinango Romy J, Casanovas Izquierdo E. Influencia de la educación para el control del fósforo sérico realizada por enfermería a pacientes y a sus cuidadores principales. Enferm Nefrol. 2014;17(2):92-7. DOI: https://doi.org/10.4321/S2254-28842014000200002
Neri L, Martini A, Andreucci VE, Gallieni M, Rey LA, Brancaccio D; MigliorDialisi Study Group. Regimen complexity and prescription adherence in dialysis patients. Am J Nephrol. 2011;34(1):71-6. DOI: https://doi.org/10.1159/000328391
Arenas MD, Pérez-García R, Bennouna M, Blanco A, Mauricio Reatiga O, Prados MD et al. Mejoría del cumplimiento terapéutico en pacientes en hemodiálisis con mal control del fósforo y mala adherencia al tratamiento con captores: Estudio COMQUELFOS. Nefrología 2013;33(2):196-203.