Effects Of A Nurse-led Intensive Education Program On Chronic Kidney Disease Patients With Hyperphosphatemia

[Objectives]To compare the effectiveness of a nurse-led intensive educaion program versus a routin care for patients who have chronic kidney disease with hyperphosphatemia.[Method]The research design in this study is a randomized controlled trial. A total of 80 chronic kidney disease patients with hyperphosphatemia (serum phosphorus> 1.78mmol/L) were randomly assigned into experimental group and control group with 40 participates in each group. The participants in the control group received the routine guidance, and the participants in the experimental group received the routin care and a nurse-led intensive educaion including educational session, one-to-one individual education and educational materials which developed by the researchers in this study. Serum phosphorus, calcium phosphorus product, calcium, albumin, and parathyroid hormone were collected at baseline,3 and 6 months after the intervention. The general knowledge (knowledge about disease, dietary, medicine as well as the health related behavior) of participants was assessed using questionnaire developed by the researchers at baseline,3 and 6 months after the intervention. Chi-square test, repeated measure ANOVA, one-way repeated measures ANOVA and Mann-Whitney U test were used to analyze the data with SPSS 16.0.【Result】The analysis within group:a) For the experimental group:the serum phosphorus and calcium phosphorus product at month 3 and 6 post-intervention were lower, and the general knowledge was higher than pre-intervention, and there was significant difference between pre and post-intervention(P<0.01); in the 3 and 6 month after intervention, the serum calcium was increased and the serum parathyroid hormone was declined, but there is no statistical significance pre and post-intervention(P>0.05); serum albumin was unchanged pre and post-intervention(P>0.05).b) For the control group, although the results showed that the decline of serum phosphorus and calcium phosphorus product, and increase of serum calcium, parathyroid hormone by month 3 and 6 after intervention, there was no statistical significant pre- and post-intervention; the general knowledge of control group was enhanced post-intervention and statistical significant was showed on pre- and post-intervention.The analysis between groups:The patients in the experimental group had a better control of serum phosphorus, calcium phosphorus product, and significant increased general knowledge and health related behavior than patients in the control group by month 3 and 6 (P<0.001). The elevated serum calcium was observed in both the experimental group and the control group, but there was no significant difference between-group (P>0.05) by month 3 and 6. No statistical significance was found in serum albumin between the groups (P >0.05). There was no significant difference between the groups on the serum parathyroid hormone (P>0.05) by month 6.[Conclusion]Hyperphosphatemia is a common secondary complication in hemodialysis patients who suffer from chronic kidney disease. A nurse-led intensive educaion program which developed by the researchers in this study was effective for the control of the increased serum phosphorus and calcium phosphorus product, and could enhance the patients'general knowledge, and also the positive effect on patients'health related behavior improvement. However, the effects of this education program on serum parathyroid hormone and the long-term effect are needed to be assessed in future study.