Kidney Week

Abstract: SA-PO1055

Comparison of Three Technology-Supported Behavioral Interventions for Phosphorus Management in Hemodialysis Patients

Session Information

• Diet and Nutrition: Clinical
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1302 Health Maintenance, Nutrition, and Metabolism: Clinical

Authors

• St-Jules, David E., NYU School of Medicine, New York, New York, United States

David E. St-Jules,

• Goldfarb, David S., NYU School of Medicine, New York, New York, United States

David S. Goldfarb,

• Pompeii, Mary Lou, NYU School of Medicine, New York, New York, United States

Mary Lou Pompeii,

• Sevick, Mary A., NYU School of Medicine, New York, New York, United States

Mary A. Sevick,

Background

Behavioral methods enhance the effectiveness of lifestyle interventions, but are often resource intensive. Although mobile health (mHealth) technology can help create lower input interventions, their feasibility, acceptability and efficacy have not been adequately evaluated in hemodialysis (HD) patients.

Methods

Maintenance HD patients with persistent hyperphosphatemia (n=40) were randomized to receive: (1) educational (Edu) videos (EDU), (2) Edu + mobile self-monitoring (SM) with MyNetDiary^® (MON), or (3) Edu + SM + social cognitive theory (SCT)-based behavioral counseling videos (SCT) over a 12-week period with videos for each group delivered using iPads. Serum phosphorus concentrations (sPO₄) were measured at baseline, 12 and 24 weeks, and a 5-point Likert scale survey on the mHealth technology was completed at 24-weeks. Two participants in the EDU group with no follow-up sPO₄ measurements were excluded; missing sPO₄ measurements at 12- and 24-weeks were imputed by carrying forward the most recent sPO₄ values.

Results

At the end of the intervention phase (12-weeks), there was a non-significant trend towards greater decreases in sPO₄ in the MON (-0.5+1.6 mg/dL, p=0.32) and SCT (-0.3+2.1 mg/dL, p=0.56) groups compared to the EDU group (+0.2+1.4 mg/dL), but these differences had mostly disappeared by the end of the monitoring phase (24-weeks) (EDU +0.1+1.2 mg/dL, MON -0.1+1.9 mg/dL, SCT -0.1+2.1 mg/dL). Most participants agreed or strongly agreed that the iPads were convenient (64%), and SM helped them stay motivated (68%), take binders (61%), and limit phosphorus intake (68%). Relatively few participants reported that they agreed or strongly agreed that they sometimes "got lost" maneuvering the iPad programs (24%), felt that SM wasn’t worthwhile (16%), or would have preferred face-to-face meetings offsite (4%).

Conclusion

Many HD patients are willing, able and report benefits of engaging in technology-supported behavioral interventions involving SM and SCT. Although these programs are easy to disseminate with limited resources once developed, any benefits for phosphorus management in HD patients may last only as long as the intervention is active.

Funding

• NIDDK Support