The effectiveness of education or behavioral interventions on adherence to phosphate control in adults receiving hemodialysis: a systematic review protocol

Abstract

Review question/objective: The objective of this review is to identify the effectiveness of education or behavioral interventions on adherence to phosphate control in adults with end stage kidney disease (ESKD) receiving hemodialysis (HD).

Background: Hyperphosphatemia occurs in people with ESKD as a result of the kidneys' reduced ability to excrete an ingested phosphate load. Hyperphosphatemia significantly lowers the serum calcium concentration, stimulating the release of parathyroid hormone (PTH), causing secondary hyperparathyroidism.3–6 In ESKD, hyperphosphatemia also slows the activation of vitamin D which leads to impaired absorption of calcium from the gastrointestinal tract, resulting in reduced mobilization of calcium and phosphate from the bones, and causing metabolic bone disease. The reduced mobilization of both phosphate and calcium enables these two minerals to bind together creating a calcium-phosphate product. At a serum concentration of >1.78mmol/L the calcium-phosphate product crystallizes and is deposited within the soft tissue and vasculature. In ESKD the development of vascular calcification of the arterial media (i.e. calciphylaxis) is a major contributing factor of morbidity and mortality.