Behavioral Management of Phosphorus in Hemodialysis Patients
Condition: Cardiovascular Disease (CKD); Hyperphosphatemia
MeSH terms: Cardiovascular Diseases; Hyperphosphatemia
Study type: Interventional

Summary: 
      The purpose of this randomized clinical trial is to evaluate alternative technology-supported
      behavioral approaches to engaging 42 maintenance hemodialysis (HD) patients with persistent
      hyperphosphatemia in phosphorus binder adherence and dietary phosphorus restriction.
      Participants will be randomized to 1 of 3 intervention groups: (1) Education (Edu); (2) Edu +
      Self-Monitoring (SM); or (3) Edu + SM + Social Cognitive Theory (SCT)-based training program.
    

Detailed description: 
      Investigators will evaluate the intervention in terms of feasibility and acceptability,
      behavior change at 12 and 24 weeks (reported phosphorus binder adherence, reported nutrient
      intakes, normalized protein catabolic rate), and clinical outcomes (serum phosphorus
      concentrations, symptoms). In addition, the impact of the different behavioral approaches on
      self-efficacy at 12 and 24 weeks, and the mediating effects of self-efficacy in facilitating
      behavioral changes and clinical outcomes will be examined.
    

Intervention name(s): Education (Edu); SM intervention; Social Cognitive Therapy (SCT)
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): This intervention will take place during weeks 1-4 at the dialysis center. Each week, study staff will present participants with a brief educational video on: phosphorus binder adherence (week 1), meeting dietary protein needs (week 2), restricting dietary sources of phosphorus (week 3), and eliminating phosphorus-based food additives (week 4). These videos will be loaded onto tablet (Personal Computers) PCs so that participants can easily view them during regular dialysis treatment.; During the first 12 weeks of the intervention, a study dietitian will review the participants' records, and provide individualized feedback via a password-protected NYULMC email address. Feedback will be provided twice per week during weeks 1-4, once per week during weeks 5-8, and once every two weeks during weeks 9-12. The email messages will focus on both the importance of self-monitoring and the behavioral targets of the intervention. Feedback will use standardized language rather than specific dietary examples to avoid providing individualized counseling to participants (which is not the purpose of the SM intervention).; This intervention will be delivered remotely online using the same tablet PCs provided for the SM intervention component of this treatment condition. The behavioral training program will focus on building a sense of self-efficacy with emphasis on mastery experiences that will include emphasizing past successes; setting incremental, easily achievable goals; self-monitoring to stay on track; identifying modifiable barriers to healthy behavior; positive feedback in goal achievement; and developing participant expertise in both the regimen and in problem solving around barriers to adherence.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Hemodialysis