Effectiveness of The Phosphate Mobile App on Serum Phosphorus in Adult Hemodialysis Patients With Hyperphosphatemia

NCT ID: NCT04789876

Last Updated: 2021-03-10

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

74 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-11-01

Study Completion Date

2020-02-29

Brief Summary

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This multi-centred randomized, open label-controlled trial consists of hemodialysis (HD) patients identified with hyperphosphatemia (\>1.78mmol/L). The intervention group received a phosphate mobile app and the control group received one-off dietary counselling for 12 weeks. Serum phosphate was measured pre-and post-intervention.

Detailed Description

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This study is a multi-centred randomized, open label-controlled trial where a total of 66 HD patients (33 intervention vs 33 control) with hyperphosphatemia were recruited from government, private and non-governmental organization settings.

Patients who consented were subjected to screening for identification of hyperphosphatemia and other eligibility criteria. Patients who fulfilled the inclusion criteria were grouped according to shift and block randomized to either the intervention or control group using a web-based randomiser.

The intervention group received a phosphate mobile app for 12 weeks and the control group received one-off phosphate counselling delivered by a dietitian with a phosphate booklet. During the 12 weeks study period, patients in both control and intervention groups were assessed at baseline and 12 weeks for changes in serum phosphorus, serum corrected calcium, phosphate knowledge, dietary intake and phosphate binder adherence.

These parameters were compared at baseline and 12 weeks for within- and between-group.

Conditions

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Hyperphosphatemia End Stage Renal Disease on Dialysis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Patients were allocated to the intervention and control group. The intervention group received a phosphate mobile app for 12 weeks and the control group received one-off dietary counselling delivered by a dietitian with a phosphate booklet.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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App Intervention Group (AIG)

Phosphate mobile app for 12 weeks.

Group Type EXPERIMENTAL

Phosphate mobile app

Intervention Type OTHER

The phosphate mobile app has the features of i) matching phosphate binder with dietary phosphate intake, ii) educational videos of phosphate management, iii) food database with local food items, iv) record-keeping and goal setting.

Dietitian Intervention Group (DIG)

One-off 45-minute dietary counselling delivered by a dietitian at the baseline of the study.

Group Type ACTIVE_COMPARATOR

One-off dietary counselling with a phosphate booklet

Intervention Type BEHAVIORAL

One-off 45-minute dietary counselling delivered by a dietitian at the baseline of the study. Patients received a complimentary phosphate booklet after the counselling session. The phosphate booklet contains similar educational information as per the phosphate mobile app excluding the matching of phosphate binder with dietary phosphate information.

Interventions

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Phosphate mobile app

The phosphate mobile app has the features of i) matching phosphate binder with dietary phosphate intake, ii) educational videos of phosphate management, iii) food database with local food items, iv) record-keeping and goal setting.

Intervention Type OTHER

One-off dietary counselling with a phosphate booklet

One-off 45-minute dietary counselling delivered by a dietitian at the baseline of the study. Patients received a complimentary phosphate booklet after the counselling session. The phosphate booklet contains similar educational information as per the phosphate mobile app excluding the matching of phosphate binder with dietary phosphate information.

Intervention Type BEHAVIORAL

Other Intervention Names

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MyKidneyDiet - Phosphate Tracker

Eligibility Criteria

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Inclusion Criteria

* Patients aged 18 years old and above.
* Patients were undergoing maintenance HD treatment for more than three months.
* Patients were on hemodialysis treatment for 4 hours per session, three times a week.
* Kt/V value (a numerical formula value to determine hemodialysis treatment adequacy. K is dialyser clearance of urea, t is dialysis time, and V is the volume of distribution of urea, approximately equal to the patient's total body water) is 1.2 and above each session.
* Patients were able to read English or Malay or Mandarin.
* Patients were on the single type of phosphate binder.
* Patients were having serum phosphorus above 1.78mmol/l and above for more than three months.
* Patients were not seen by a dietitian for the past one year for phosphate education.
* Patients did not have ward admission for the past three months.
* Patients did not have dementia or developmental delay.
* Patients owned and able to use a smartphone.
* Patients were able to use at least one comprehensive mobile application independently.
* Patients had access to the internet/data plan.
* Patients were willing to adhere to all study requirements and protocol.
* Patients were willing to accept the publication of data without exposing their name.

Exclusion Criteria

* Patients were on incremental or acute hemodialysis.
* Patients had ward admission three months prior to the study and during the study period.
* Patients were terminally ill.
* Patients had cognitive impairment or physical disabilities (visual, hand dexterity, etc.) hindering interview and PMA utilisation.
* Patients had visual impairment or blind hindering the interview or the use of PMA.
* Patients were unable to self-care and dependent.
* Patients stayed in an institutionalised setting.
* Patients had undergone parathyroidectomy.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Taylor's University

OTHER

Sponsor Role lead

Responsible Party

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Tilakavati Karupaiah

SRI Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Tilakavati Karupaiah, PhD

Role: PRINCIPAL_INVESTIGATOR

Taylor's University

Teong Lee Fang, BSc

Role: STUDY_CHAIR

Taylor's University

Locations

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Pusat Rawatan Dialisis Islah

Batu Caves, Selangor, Malaysia

Site Status

National Kidney Foundation Malaysia

Petaling Jaya, Selangor, Malaysia

Site Status

Hospital Kuala Lumpur

Kuala Lumpur, , Malaysia

Site Status

Countries

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Malaysia

References

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Ketteler M, Block GA, Evenepoel P, Fukagawa M, Herzog CA, McCann L, Moe SM, Shroff R, Tonelli MA, Toussaint ND, Vervloet MG, Leonard MB. Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder: Synopsis of the Kidney Disease: Improving Global Outcomes 2017 Clinical Practice Guideline Update. Ann Intern Med. 2018 Mar 20;168(6):422-430. doi: 10.7326/M17-2640. Epub 2018 Feb 20.

Reference Type BACKGROUND
PMID: 29459980 (View on PubMed)

Umeukeje EM, Mixon AS, Cavanaugh KL. Phosphate-control adherence in hemodialysis patients: current perspectives. Patient Prefer Adherence. 2018 Jul 4;12:1175-1191. doi: 10.2147/PPA.S145648. eCollection 2018.

Reference Type BACKGROUND
PMID: 30013329 (View on PubMed)

Chan MW, Cheah HM, Mohd Padzil MB. Multidisciplinary education approach to optimize phosphate control among hemodialysis patients. Int J Clin Pharm. 2019 Oct;41(5):1282-1289. doi: 10.1007/s11096-019-00878-4. Epub 2019 Jul 13.

Reference Type RESULT
PMID: 31302884 (View on PubMed)

Milazi M, Bonner A, Douglas C. Effectiveness of educational or behavioral interventions on adherence to phosphate control in adults receiving hemodialysis: a systematic review. JBI Database System Rev Implement Rep. 2017 Apr;15(4):971-1010. doi: 10.11124/JBISRIR-2017-003360.

Reference Type RESULT
PMID: 28398983 (View on PubMed)

Fakih El Khoury C, Crutzen R, Schols JMGA, Halfens RJG, Karavetian M. A Dietary Mobile App for Patients Undergoing Hemodialysis: Prospective Pilot Study to Improve Dietary Intakes. J Med Internet Res. 2020 Jul 20;22(7):e17817. doi: 10.2196/17817.

Reference Type RESULT
PMID: 32706698 (View on PubMed)

Elder GJ, Malik A, Lambert K. Role of dietary phosphate restriction in chronic kidney disease. Nephrology (Carlton). 2018 Dec;23(12):1107-1115. doi: 10.1111/nep.13188.

Reference Type RESULT
PMID: 29064141 (View on PubMed)

Reddy V, Symes F, Sethi N, Scally AJ, Scott J, Mumtaz R, Stoves J. Dietitian-led education program to improve phosphate control in a single-center hemodialysis population. J Ren Nutr. 2009 Jul;19(4):314-20. doi: 10.1053/j.jrn.2008.11.001.

Reference Type RESULT
PMID: 19539185 (View on PubMed)

Vrdoljak I, Panjkota Krbavcic I, Bituh M, Leko N, Pavlovic D, Vrdoljak Margeta T. The impact of education and cooking methods on serum phosphate levels in patients on hemodialysis: 1-year study. Hemodial Int. 2017 Apr;21(2):256-264. doi: 10.1111/hdi.12468. Epub 2016 Aug 16.

Reference Type RESULT
PMID: 27528215 (View on PubMed)

Other Identifiers

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NMRR-19-3825-45381

Identifier Type: REGISTRY

Identifier Source: secondary_id

HEC 2019/011

Identifier Type: -

Identifier Source: org_study_id

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