Intensive Dietary Education to Lower Serum Phosphorus in Patients With Chronic Kidney Disease
Intensive Dietary Education to Lower Serum Phosphorus in Patients With Chronic Kidney Disease
A low phosphorus diet is recommended for patients with chronic kidney disease who exhibit
 high levels of phosphorus. The purpose of this study is to determine the effects of a more
 intensive, innovative dietary phosphorus educational intervention on reducing serum
 phosphorus levels, as well as improving dietary adherence, dietary satisfaction and
 phosphorus knowledge level in patients with chronic kidney disease.
High serum phosphorus concentration (hPhos) commonly occurs in chronic kidney disease (CKD)
 secondary to declining renal function. hPhos increases the risk of developing metastatic
 calcification, secondary hyperparathyroidism, renal osteodystrophy and cardiovascular
 complications. Patients with hPhos are advised to restrict their dietary phosphorus intake to
 800-1000mg/d, as per National Kidney Foundations'Kidney Disease Quality Outcomes Initiative
 (KDOQI). Adherence to a phosphorus restricted diet is often challenging for CKD patients, as
 they may be required to follow various dietary restrictions, and there is significant
 quantities of hidden phosphorus in processed foods. This randomized controlled trial is
 designed to compare the effectiveness of more intensive phosphorus education (IPE) using the
 innovative Phosphorus Point System Tool© versus standard phosphorus education (SPE) using the
 Choose/Avoid list on 1) serum phosphorus levels (primary outcome) 2) dietary adherence,
 dietary knowledge and satisfaction in patients with pre-dialysis CKD. We hypothesize that
 patients receiving IPE will have lower serum phosphorus than those receiving SPE. Fifty
 patients attending a pre-dialysis CKD clinic with serum phosphorus > 1.49 mmol/L will be
 randomly assigned to IPE or SPE and followed over 12 weeks. Serum phosphorus, dietary intakes
 using the 5-pass repeat 24-hour dietary recall method, dietary knowledge and satisfaction by
 validated questionnaires, will be measured at baseline, 6 weeks and 12 weeks. The study's
 findings on the impact of more intensive innovative dietary phosphorus education in patients
 with pre-dialysis CKD will serve towards developing best practice of care and potentially
 reduce long-term complications.
Inclusion Criteria:

 -  ≥ 18 years old

 -  Patient with pre-dialysis CKD attending the Progressive Renal Disease Clinic (PRDC) at
 St. Michael's Hospital

 -  Six-month mean serum phosphorus > 1.35 mmol/L

 -  Able to provide informed consent

 Exclusion Criteria:

 -  Currently on dialysis

 -  Current malignancy

 -  Inability to use Phosphorus Point System (PPS) Tool