Improving CKD-MBD management in haemodialysis patients: Barrier analysis for an implementation project.

Aim: To determine barriers towards an evidence-practice gap by surveying haemodialysis (HD) patients and staff about awareness and management of chronic kidney disease mineral and bone disorder (CKD-MBD). Background(s): Although guidelines exist for optimal levels of serum markers of CKD-MBD, target parameters are not achieved in many HD patients. The reason for this evidence-practice gap is unclear and more information from patients and healthcare professionals is required to improve knowledge transfer. Method(s): 136 prevalent HD patients, 25 nephrologists and 58 dialysis nurses/ technicians were surveyed. Three separate questionnaires included issues of knowledge and awareness of CKD-MBD and factors limiting management (including compliance, medications and general understanding). Result(s): 1. HD patients: 84% had heard about phosphate, 24% aware of normal levels; 54% were aware of consequences of elevated phosphate; 42% were unsure of high phosphate foods; 27% had difficulty taking and 35% admitted to forgetting to take phosphate binders; and 74% wanted to know more about CKD-MBD (40% via written material). 2. Nephrologists: 52% were aware of a CKD-MBD protocol in their unit and 60% were satisfied with CKD-MBD management; 76% thought non-compliance with binders was the main reason for poor control of phosphate (predominantly related to insufficient understanding of phosphate, binders and consequences of elevated levels); 84% thought patients wanted to know more but only 7% provided written material on CKD-MBD. 3. Dialysis nurses/technicians: 63% thought non-compliance with binders was the predominant reason for poor control, main reasons again being lack of patient understanding; 88% thought patients would want to know more but only 17% provided written education. Conclusion(s): Implementation of an intensive educational program, with a multi-faceted approach, for HD patients may promote better control CKD-MBD and improve achievement of target levels.