Educational strategies to reduce serum phosphorus in hyperphosphatemic patients with chronic kidney disease: systematic review with meta-analysis.
OBJECTIVE
To systematically review educational strategies for phosphorus reduction in patients with hyperphosphatemia and chronic kidney disease (CKD).


DESIGN
Systematic review with meta-analysis.


DATA SOURCES
CENTRAL, MEDLINE, EMBASE, and mRCT databases were assessed in June 2010.


STUDY SELECTION
Randomized controlled trials evaluating educational strategies related to diet in hyperphosphatemic patients with CKD. DATA EXTRACTION AND SYNTHESIS METHOD: Study characteristics, phosphorus levels, and calcium-phosphorus product levels were retrieved. Jadad scale was used for quality assessment. Mean difference (MD) and 95% confidence intervals (CIs) were calculated by random effects method.


RESULTS
Seven randomized controlled trials were retrieved with a total of 524 patients with hyperphosphatemia and CKD. Educational strategies reduced phosphorus levels with an MD of -0.72 mg/dL (95% CI: -1.11 to -0.33, P < .01). Sensitivity analysis of trials with follow-up of <4 months did not show any benefit of the intervention, but educational intervention for ≥ 4 months showed an MD of -1.07 (95% CI: -1.49 to -0.64, P < .01). Calcium-phosphorus product level was improved in 227 evaluated patients from 5 trials with an MD of -5.22 mg(2)/dL(2) (95% CI: -9.48 to -0.98, P = .02, and I(2) = 58%). Sensitivity analysis removed the source of heterogeneity and resulted in an MD of -3.02 (95% CI: -6.51 to 0.47, P = .09).


CONCLUSIONS
Education helped reduce phosphorus levels in hyperphosphatemic patients with CKD, particularly those on dialysis.