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Understanding Dietary Phosphorus in CKD Patients

Learn about effects of dietary phosphorus in CKD patients, hyperphosphatemia, serum phosphorus levels, and recommended treatments. Explore high-phosphorus foods and additives, ESRD KDOQI guidelines, monitoring, and dietary intake recommendations.

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Understanding Dietary Phosphorus in CKD Patients

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  1. Dietary Phosphorus And Its Effect in Patients with CKD Melanie Boney

  2. Serum Phosphorus • Hyperphosphatemia • CVD due to vascular calcification • ↑ serum phosphorus levels associated with ↑ mortality • CKD patients • People without CKD

  3. Serum Phosphorus • Treatments • Phosphorus binders to decrease GI absorption • Elimination via dialysis • Dietary restriction

  4. Foods High in Phosphorus • Colas • Dairy • Seafood • Nuts, Seeds & Legumes • Cereal, whole wheat

  5. Foods High in Phosphorus • Processed Foods • Cheeses • Meats • Salad Dressing • Bakery Products • Beverages

  6. Phosphorus Additives • Extend product shelf life • Improve color • Enhance flavor • Retain moisture

  7. ESRD KDOQI Guidelines • Phosphorus restricted to 800-1000 mg/day • When serum phosphorus levels are ≥5.5 mg/dL • When plasma levels of PTH are >300 pg/mL • Serum phosphorus levels should be monitored every month following the initiation of dietary phosphorus restriction

  8. Dietary Phosphorus Intake • 1200 mg/ day = 8400 mg/week • ~60% Absorbed • Total to Remove ~5040 mg/week • Dialysis 3000mg/week (1000 mg/session) • Binders MUST Remove 2040 mg/week • Increase by 300 mg/day = 10,500 mg/week • 25% Increase = MORE BINDERS

  9. Conclusion

  10. Beverages High in Phosphorus * Based on 12 oz servings

  11. References • Sherman RA, Mehta O: Phosphorus and Potassium Content of Enhanced Meat and Poultry Products: Implications for Patients Who Receive Dialysis. Clin J Am Soc Nephrol 4:1370-1373, 2009. • Noori N, Kalantar-Zadeh K, Kovesdy CP, Bross R, Benner D, Kopple JD: Association of Dietary Phosphorus Intake and Phosphorus to Protein Ratio with Mortality in Hemodialysis Patients. Clin J Am Soc Nephrol 5: 683-692, 2010. • Kalantar-Zadeh K, Gutekunst L, Mehrotra R, Kovesdy CP, Bross R, Shinagerger CS, Noori N, Hirschberg R, Brenner D, Nissenson AR, Kopple JD: Understanding Sources of Dietary Phosphorus in the Treatment of Patients with Chronic Kidney Disease. Clin J Am Soc Nephrol 5 519-503, 2010. • KDOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease. American Journal of Kidney Disease 42: 3, 1-202, 2003.

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