S 27 Parallel Session

GUEST SPEAKER
Hidden phosphorus in the diet – consequences for CKD patients and the general population
M.K. Kuhlmann^1
1Internal Medicine - Nephrology, Vivantes Klinikum im Friedrichshain, Berlin, Germany

Background
Hyperphosphatemia has been identified as a strong predictor of mortality in advanced kidney disease (CKD). A recent study of patients in stage CKD 5 revealed that 12% of all deaths in this group were attributable to an elevated serum phosphate concentration. A high-normal serum phosphate concentration has been found to be an independent predictor of cardiovascular events and mortality in the general population. Therefore, phosphate containing additives in food are a matter of concern.

Results
Dietary phosphate content is closely associated with protein content. The natural organic phosphate esters contained in foods is only incompletely absorbed and restricting its intake may result in protein malnutrition. On the other hand, inorganic phosphate in food additives is effectively absorbed and can measurably elevate the serum phosphate concentration in patients with advanced CKD. While processed food and "fast food" contain high amounts of phosphate containing food additives this is not the case for biologic food, where most phosphate contaiing additives are not permitted. The main pathophysiological effect of phosphate is vascular damage and vascular calcification. Patients with advanced renal failure are advised to limit their daily phosphate intake by carefully selecting meals and specifically avoiding phosphate additives containing food components.

Conclusion/Application to practice
Although prospective controlled trials are currently unavailable, renal patients as well as the public should be informed that phosphate containing food additives may be damaging to health. European calls for labeling total phosphate content of foods or the content of phosphate additives have been issued.
BIOGRAPHY OF THE GUEST SPEAKER

O 68
Adherence of dietary and fluids restrictions and self efficacy in patients undergoing haemodialysis
M. Mollaoglu¹, B. Yürügen^2
1Cumhuriyet University, Sivas, Turkey; 2Okan University, İstanbul, Turkey

Background
Many haemodialysis patients have difficulty complying with fluid and dietary restrictions. These patients require major lifestyle changes. A person with an increased perception of self-efficacy is more likely to participate in self-care activities, which increase the patient's adherence to the treatments.

Objectives
The aim of the study is investigate relationship between the adherence to dietary-fluid restrictions and self-efficacy in haemodialysis patients.

Methods
This is a descriptive cross-sectional study with a convenience sample of 146 haemodialysis patients.  Data were collected by using a Personal Information Form, Nonadherence Questionnaire with Dialysis Diet and Fluid Restrictions and General Self-Efficacy Scales.

Results
Frequency of non-adherence to fluid was more common in patients. In total, 79 patients (54.2 %) reported mild to very severe nonadherence to diet, and 88 patients (60.3 %) reported mild to very severe nonadherence to fluid restrictions. There was a significant relationship between adherence to dietary - fluid restrictions and self efficacy. Noncompliance in  dietary and fluid restrictions were related to some personal and clinical characteristics of patients. The results of this study showed that nonadherence was more common among older, low educated patients and  those with lower levels of self efficacy.

Conclusion/Application to practice
Fluid and dietary non-adherence were highly prevalent in our patients receiving haemodialysis.Early identification and appropriate interventions may potentially lead to improvement in adherence of these patients. Health professionals providing care to  patients should consider these individuals' sense of self efficacy and fluid- dietary nonadherence at the time care is delivered. For these  renal patients  coping with the  disease and treatments, these concepts are extremely important.

BIOGRAPHY OF THE SPEAKER

O 69
Inpatient compliance with phosphate binder prescription
A. Killeen¹, L. Kelly², T. Rennick³, M. Bergstrom¹, S. Boyd⁴, E. Bergin^1
1Renal Services, Midland Regional Hospital, Tullamore, Ireland; ²Pharmacy Department, Midland Regional Hospital, Tullamore, Ireland; ³Department of Dietetics, Midland Regional Hospital, Tullamore, Ireland; ⁴Medical 1, Midland Regional Hospital, Tullamore, Ireland

Background
Hyperphosphataemia is a predictor of cardiovascular mortality in patients with chronic kidney disease. Phosphate binder ingestion should be timed with a meal to limit phosphate absorption. A previous audit demonstrated low compliance of binder administration at mealtimes. Strategies to improve binder ingestion were agreed, implemented and re-audited.

Objectives
To determine whether implementing changes in practice would increase the proportion of phosphate binders ingested with meals.

Methods
Renal inpatients prescribed a phosphate binder on a single medical ward were included in a prospective observational audit. Changes in practice included nursing staff education, binder notification on the nursing handover document, alteration of binder container labelling and increasing prescriber awareness of correct binder prescribing. Re-audit was conducted together with a survey of nurse opinion on the effectiveness of interventions implemented.

Results
The initial audit observed 34 binder ingestion opportunities in 9 inpatients while re-audit observed 56 opportunities in 13 patients. The proportion of binders ingested with a meal increased from 2.9% (1 of 34) to 37.5% (21 of 56) The proportion of inappropriate binder administration decreased from 88.2% (30 of 34) to 53.6% (30 of 56). Feedback from nurses indicated the majority of changes implemented were helpful in improving binder ingestion with meals.

Conclusion/Application to practice
Changes in practice led to a significant increase in phosphate binder compliance. A continuous programme of staff awareness and resources for patient education are being explored to promote binder adherence, including self-administration.

BIOGRAPHY OF THE SPEAKER

O 70
New technologies to improve the diet of patients with hypertension or Chronic kidney disease
M. Fenollar¹, G. Casals¹, J.M. Galceran¹, A. Morera^1
1Nephrology, Fundació Althaia, Manresa, Spain

Background
Many diseases have dietary requirements to improve their control and prevent complications. Hypertensive patients should reduce sodium intake,  in Chronic Renal Disease it is important to reduce potassium and phosphorus intake because their excessive accumulation increases the risk of arrhythmias, vascular calcification and cardiovascular mortality. Our Nephrology Department at the Althaia Foundation, Barcelona, Spain, in synergy with a private Health & Nutrition foundation, have developed PUKONO, an application for mobile phones and tablets. It provides instant information about Sodium, Potassium and Phosphorus content in food, including  a section with recommendations  how to make food safer and a number of appropriate recipes. These are presented in an easy and attractive way, which aims to improve both safety and patients’ quality of life. We have conducted an observational, descriptive study with the data retrieval platform "Flurry" to assess the usability of the application.
1.5 years after its launch, the application has been downloaded by 10,145 users; 1.145 of which (11.19%) are considered active users. The average rate of new users is 563/month and since its inception it has remained among the 30 most downloaded health-applications in Spain. The total number of consultations has been 240,999 and the average time per consultation 56.4 seconds. User ratings are highly favorable (overall rating: 4.2/5 for Android and 5/5 for iOS). Most queries (76.5%) are about the safety of a particular food. Our results suggest that PUKONO is a useful tool for patients and for their caregivers, in the choice of a safe and varied diet.

BIOGRAPHY OF THE SPEAKER

O 71
Phosphorus levels and treatment adherence in patients with chronic kidney disease on haemodialysis
A. Saraiva¹, S. Ribeiro¹, A. Seabra¹, N. Gomes¹, C. Antunes², J. Fazendeiro Matos³, M.T. Parisotto^4
1NephroCare Coimbra, Fresenius Medical Care, Coimbra, Portugal; ²NephroCare Portugal, Fresenius Medical Care, Lisboa, Portugal; ³NephroCare Portugal, Fresenius Medical Care, Porto, Portugal; ⁴Care Value Management EMEA, Fresenius Medical Care, Bad Homburg, Germany

Background
Hyperphosphataemia in haemodialysis patients is associated with major health problems. This situation is often associated with non-adherence to treatment. Authors seem to address this issue from two different and dissociated perspectives: pharmacological or nutritional.

Objectives
• Analyse the relation between phosphorus levels and adherence to drug therapy and nutrition recommendations.
• Assess the impact of a multidisciplinary teaching programme on phosphorus levels and treatment adherence.

Methods
This is a quantitative, descriptive, correlational and analytical study and entails the implementation of a multidisciplinary three months education programme.
Patients were selected according to inclusion criteria and divided into 3 groups (A, B and C). Groups A and B will consist of patients with normal phosphorus values. Group C will consist of patients with phosphorus levels above the normal range. The teaching programme will be applied in Groups B and C.
Phosphorus levels will be assessed through the average measurement of monthly values for the quarter prior to the education programme and the average for the three months during the education programme. Adherence to medication will be evaluated by using the Measure Treatment Adherence scale. Adherence to dietary recommendations will be assessed through a questionnaire pertaining to knowledge and attitudes about nutrition and food intake records.

Results
There aren't conclusive results at this point because the study ends in May of 2016.

Conclusion/Application to practice
With a multidisciplinary approach, we want to optimise hyperphosphataemia treatment by focussing on the patient's own role in their treatment and recovery and we expect to improve patient's medical condition and decrease health costs.