European hemodialysis patient satisfaction with phosphate binders is associated with serum phosphorus levels: the Dialysis Outcomes and Practice Patterns Study.
Author
McCullough, KeithPort, Friedrich K
de Sequera, Patricia
Rayner, Hugh
Pecoits-Filho, Roberto
Walpen, Sebastian
Evenepoel, Pieter
Pisoni, Ronald L
Publication date
2021-06-11Subject
Nephrology/Renal medicine
Metadata
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Background: Hemodialysis (HD) patients are commonly prescribed phosphate binders (PBs) to manage serum phosphorus levels, as hyperphosphatemia is strongly associated with poorer survival. Nonadherence with the PB prescription is associated with elevated serum phosphorus levels. We studied associations between patient satisfaction with their PB and serum phosphorus levels and mortality rates. Methods: Adult HD patients in Germany, Italy, Spain and the UK in the Dialysis Outcomes and Practice Patterns Study were administered a survey instrument in late 2017. Patients were asked about their satisfaction with their PBs, as measured through three questions (difficulty, inconvenience and dissatisfaction) on a 5-point Likert scale, with each dichotomized into average worst versus good responses. These were used as predictors in linear regression models of continuous serum phosphorus levels and in Cox proportional hazards models of mortality, with adjustments for demographics, comorbidities and laboratory values. Results: Patients having greater difficulty, inconvenience and dissatisfaction with their PB had higher serum phosphorus levels in adjusted models {+0.21 mg/dL [95% confidence interval (CI) ±0.23], +0.30 (±0.21) and 0.36 (±0.22), respectively}, and higher odds of having serum phosphorus levels ≥6.0 mg/dL. Measures of dissatisfaction were also associated with an elevated risk of mortality, with adjusted hazard ratios of 2.2 (95% CI 1.3-3.6), 1.6 (1.0-2.6) and 1.7 (1.1-2.7), respectively; this association was not strongly affected by adjustment for baseline serum phosphorous level. Conclusions: Self-reported difficulty, inconvenience and dissatisfaction in taking one's prescribed PBs were associated with elevated serum phosphorus levels and serum phosphorus levels above clinically meaningful thresholds. While the mechanism for the association with mortality is unclear, patient-reported satisfaction should be considered when attempting to manage patient serum phosphorus levels.Citation
McCullough K, Port FK, de Sequera P, Rayner H, Pecoits-Filho R, Walpen S, Evenepoel P, Pisoni RL; DOPPS Country Investigators. European hemodialysis patient satisfaction with phosphate binders is associated with serum phosphorus levels: the Dialysis Outcomes and Practice Patterns Study. Clin Kidney J. 2021 Jun 11;14(8):1886-1893. doi: 10.1093/ckj/sfab098Type
ArticleAdditional Links
https://academic.oup.com/ckjPMID
34345411Journal
Clinical Kidney JournalPublisher
Oxford University Pressae974a485f413a2113503eed53cd6c53
10.1093/ckj/sfab098