Hyperphosphatemia in end-stage renal disease (ESRD) patients is a non-traditional risk factor for all-cause and cardiovascular mortality. Non-adherence to phosphate binders is as high as 74% in ESRD patients and has been shown to be most related to psychosocial factors including attitudes. There is limited data on the influence of attitudes and perceived autonomy support on phosphate binder adherence and these two psychosocial constructs can be positively influenced through the use of motivational interviewing skills to increase autonomous motivation. Furthermore, racial disparities are known to exist in ESRD however and there are still gaps, which exist in understanding the determinants of disparities in adherence in vulnerable patients with ESRD. The PI conducted a pilot study in100 prevalent dialysis patients, which revealed that positive attitudes correlated with higher binder medication adherence (p=0.04) and medication adherence correlated with serum phosphorus levels (p<0.001). Greater perceived autonomy support was associated with both better medication adherence (p=0.017) and better phosphorus control and subtle underlying differences by race were noted. The overarching objective of this proposal is for the PI to gain critical research experience and skills by determining the impact of motivational interviewing on phosphate binder adherence in diverse ESRD patients. Through this project, the PI will gain valuable research experience in study design, implementation, analysis and dissemination of research findings, and these will effectively set the foundation for a successful career as a patient-oriented clinical investigator. The PI has outlined a training plan that integrates structured research training through the MPH Program;a mentored research experience;participation in local and national research meetings / conferences and active involvement in an innovative and extremely supportive research environment. This proposed award will facilitate the PI to gain experience and comprehensive training in patient-oriented clinical research to (a) successfully obtain a career development research award to address disparities in kidney disease and ultimately to (b) set the stage for an independently funded research career identifying and overcoming gaps in care by leading behavioral clinical trials testing novel multi-level strategies and translating them to clinical care.

Public Health Relevance

High phosphorus levels result from non-adherence to phosphate binders and contribute to the high death rate in end-stage renal disease (ESRD). Preliminary studies suggest a strong association between attitudes, perceived autonomy support, phosphate binder adherence and serum phosphorus control and also suggest subtle underlying differences by race. This proposed study would extend this research by evaluating a behavioral intervention based on the use of motivational interviewing skills to improve attitudes and perceived autonomy support and thus, improve phosphate binder adherence.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Postdoctoral Individual National Research Service Award (F32)
Project #
1F32DK102366-01A1
Application #
8833932
Study Section
Special Emphasis Panel (ZDK1)
Program Officer
Rankin, Tracy L
Project Start
2014-09-09
Project End
2015-09-08
Budget Start
2014-09-09
Budget End
2015-09-08
Support Year
1
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Vanderbilt University Medical Center
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
City
Nashville
State
TN
Country
United States
Zip Code
37212
Umeukeje, Ebele M; Wild, Marcus G; Maripuri, Saugar et al. (2018) Black Americans' Perspectives of Barriers and Facilitators of Community Screening for Kidney Disease. Clin J Am Soc Nephrol 13:551-559
Umeukeje, Ebele M; Merighi, Joseph R; Browne, Teri et al. (2016) Health care providers' support of patients' autonomy, phosphate medication adherence, race and gender in end stage renal disease. J Behav Med 39:1104-1114
Umeukeje, Ebele M; Merighi, Joseph R; Browne, Teri et al. (2015) Self-Motivation Is Associated With Phosphorus Control in End-Stage Renal Disease. J Ren Nutr 25:433-9