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  • Subject Name : Nursing

Management of Phosphate Level in Dialysis Patients

Table of Contents

Part A: Presentation.

Introduction.

Target clients.

Review available literature.

Conclusion.

Part B: Summary.

Introduction.

Key strategies to improve education and self-management promotion.

Critical reflection of planning.

Conclusion.

References

Introduction to Hyperphosphatemia in Dialysis Patients

Phosphorus (P; atomic weight 31 Daltons) is the mineral, which is widely available in the nature as phosphate. In human body, it has an essential duty in bone metabolism, nucleolus, cellular signalling, and energy metabolism (de Francisco et al. 2018, p. i.37). The patients with CKD (Chronic Kidney Disease) may face challenges regarding phosphate binders, which prevent phosphorus absorption from food.

Target Clients

Based on the former evaluation, it can be proved that the factor specifically targets patients, who have CKD. The patients with aforementioned disease, may faces challenges while absorbing phosphorus from their daily diets, and the kidney of those people are failed to do its duties like extracting waste from the body or blood, balancing fluid level in the body, urine formation, and even blood pressure regulation as well (Sherman 2016, p. 184). By dialysis, the care givers are targeting to make balance in body fluids and help the patient’s cells to extract phosphorus and other essential elements from daily diet habits.

Review Available Literature

After gaining adequate knowledge from various previous researches about the topic, it can be identified that the medication in phosphate binder can be classified into two sections, as calcium-based binder along with non-phosphate binders (Hanudel et al. 2018, p. 2139). Based on the available information, it can be identified that the phosphate binder (Calcium-based) is less expensive than the other one, however; the process is risky for balancing positive calcium.

Although, the research also includes that despite having numerous advanced technologies for dialysis and quality membranes, the challenge in this medication process cannot be discarded till date. The issue related to P removal cannot be controlled under a structured and even pace by the healthcare experts (Cupisti, Adamasco et al. 2013, p. 193).

However, the accumulation of phosphate in the body of a CKD patient is highly risky. As per the viewpoint of D’Alessandro et al. (2015, p. 5), the accumulation of phosphate in the body, reacts with calcium of bones and invokes decay in the bone which is highly degenerative for the patient. Moreover, Unhealthy deposition of calcium sulphate often invokes cardiac diseases

Hence, minimisation of the decay cam is managed with the administration of phosphate binding drugs for the patients. As per the research of Van Buren et al (2015, p. 485), the administration of Ferric citrate, lanthanum carbonate or sucroferric oxyhydroxide are the major phosphate binders which are commonly used for CKD patients as per their comorbidities.

Contextually, it can be identified that in the large mass removal of requiring P, diffusion is not sufficient with both standard membranes or high-efficiency as well (Hanudel et al. 2018, p. 2139). With conventional dialysis diffusive regimen, P removal rate is highly variable, which is presented in the above table. Hence, it can be advised that the patients with taking 1.2 g/kg/day, they need to intake intestinal binders (P) as well (Sherman, 2016 p. 183).

Session plan with potential learning objectives

Objectives

Details

Learning resources

Learning activities

P removal challenge

Most successfully implicated P removal process is precipitation of chemical phosphorus with addition to metal salts. Dissolved phosphorus is transformed to solids and removed from waste water

Daneshgar, S., Callegari, A., Capodaglio, A.G. and Vaccari, D., 2018. The potential phosphorus crisis: resource conservation and possible escape technologies: a review. Resources, 7(2), p.37.

Trainer led healthcare activity

Phosphate binder management

This is important for the caregivers to help the patient’s body cells to absorb phosphorus from daily diet 

Cupisti, Adamasco and Gallieni, Maurizio and Rizzo, Maria and Caria, Stefania and Meola, Mario and Bolasco, Piergiorgio. (2013). Phosphate Control in Dialysis. International journal of nephrology and renovascular disease. 6. 193-205. 10.2147/IJNRD.S35632

Individual checklist

Keep body chemicals

By offering dialysis to CKD patients, the caregivers strengthen the kidneys of patients to manage waste level, water level, and even chemical levels

https://www.kidney.org/atoz/content/dialysisinfo

Trainer-led explanation

Table 1: Session plan

(Source: Created by the researcher)

Conclusion on Hyperphosphatemia in Dialysis Patients

Hence, it can be concluded that the process of dialysis is significant for the patients with CKD symptoms, as this can help them to manage body fluid level. Besides this, the process is effective for the patients to support their kidneys to work effectively within the body to manage waste level of the blood.

References for Hyperphosphatemia in Dialysis Patients

1st part

D’Alessandro, C., Piccoli, G.B. and Cupisti, A., 2015. The “phosphorus pyramid”: a visual tool for dietary phosphate management in dialysis and CKD patients. BMC nephrology, 16(1), pp.1-6.

Cupisti, A., Gallieni, M., Rizzo, M.A., Caria, S., Meola, M. and Bolasco, P., 2013. Phosphate control in dialysis. International Journal Of Nephrology And Renovascular Disease, 6, p.193.

Daneshgar, S., Callegari, A., Capodaglio, A.G. and Vaccari, D., 2018. The potential phosphorus crisis: resource conservation and possible escape technologies: a review. Resources, 7(2), p.37.

de Francisco, A., Fouque, D., Boletis, I., Vervloet, M., Kalra, P., Ketteler, M., Messa, P., Stauss-Grabo, M., Derlet, A., Rakov, V. and Walpen, S., 2018. Fo047 real-world effectiveness of sucroferric oxyhydroxide for serum phosphorus control in dialysis patients: an interim subgroup analysis of the verifie study. Nephrology Dialysis Transplantation, 33(suppl_1), pp.i37-i38.

Hanudel, M.R., Laster, M., Ramos, G., Gales, B. and Salusky, I.B., 2018. Clinical experience with the use of ferric citrate as a phosphate binder in pediatric dialysis patients. Pediatric Nephrology, 33(11), pp.2137-2142.

kidneynews.org, 2020, Physical Activity and Kidney Disease available at: https://www.kidneynews.org/kidney-news/clinical-care/physical-activity-and-kidney-disease [accessed on: 11th September 2020]

Sherman, R.A., 2016. Hyperphosphatemia in dialysis patients: Beyond nonadherence to diet and binders. American Journal of Kidney Diseases, 67(2), pp.182-186.

Van Buren, P.N., Lewis, J.B., Dwyer, J.P., Greene, T., Middleton, J., Sika, M., Umanath, K., Abraham, J.D., Arfeen, S.S., Bowline, I.G. and Chernin, G., 2015. The phosphate binder ferric citrate and mineral metabolism and inflammatory markers in maintenance dialysis patients: results from prespecified analyses of a randomized clinical trial. American Journal of Kidney Diseases, 66(3), pp.479-488.

2nd part

Affret, A., Wagner, S., El Fatouhi, D., Dow, C., Correia, E., Niravong, M., Clavel-Chapelon, F., De Chefdebien, J., Fouque, D., Stengel, B. and Boutron-Ruault, M.C., 2017. Validity and reproducibility of a short food frequency questionnaire among patients with chronic kidney disease. BMC nephrology, 18(1), p.297.

D’Alessandro, C., Piccoli, G.B. and Cupisti, A., 2015. The “phosphorus pyramid”: a visual tool for dietary phosphate management in dialysis and CKD patients. BMC nephrology, 16(1), pp.1-6.

de Fornasari, M.L.L. and dos Santos Sens, Y.A., 2017. Replacing phosphorus-containing food additives with foods without additives reduces phosphatemia in end-stage renal disease patients: a randomized clinical trial. Journal of Renal Nutrition, 27(2), pp.97-105.

Dhillon‐Jhattu, S. and Sprague, S.M., 2018, July. Should phosphate management be limited to the KDIGO/KDOQI guidelines?. In Seminars in dialysis (Vol. 31, No. 4, pp. 377-381).

Narva, A.S., Norton, J.M. and Boulware, L.E., 2016. Educating patients about CKD: the path to self-management and patient-centered care. Clinical journal of the American Society of Nephrology, 11(4), pp.694-703.

Van Buren, P.N., Lewis, J.B., Dwyer, J.P., Greene, T., Middleton, J., Sika, M., Umanath, K., Abraham, J.D., Arfeen, S.S., Bowline, I.G. and Chernin, G., 2015. The phosphate binder ferric citrate and mineral metabolism and inflammatory markers in maintenance dialysis patients: results from prespecified analyses of a randomized clinical trial. American Journal of Kidney Diseases, 66(3), pp.479-488.

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