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Effect of food additives on hyperphosphatemia among patients with end-stage renal disease: a randomized controlled trial.
JAMA. 2009 Feb 11; 301(6):629-35.JAMA

Abstract

CONTEXT

High dietary phosphorus intake has deleterious consequences for renal patients and is possibly harmful for the general public as well. To prevent hyperphosphatemia, patients with end-stage renal disease limit their intake of foods that are naturally high in phosphorus. However, phosphorus-containing additives are increasingly being added to processed and fast foods. The effect of such additives on serum phosphorus levels is unclear.

OBJECTIVE

To determine the effect of limiting the intake of phosphorus-containing food additives on serum phosphorus levels among patients with end-stage renal disease.

DESIGN, SETTING, AND PARTICIPANTS

Cluster randomized controlled trial at 14 long-term hemodialysis facilities in northeast Ohio. Two hundred seventy-nine patients with elevated baseline serum phosphorus levels (>5.5 mg/dL) were recruited between May and October 2007. Two shifts at each of 12 large facilities and 1 shift at each of 2 small facilities were randomly assigned to an intervention or control group.

INTERVENTION

Intervention participants (n=145) received education on avoiding foods with phosphorus additives when purchasing groceries or visiting fast food restaurants. Control participants (n=134) continued to receive usual care.

MAIN OUTCOME MEASURE

Change in serum phosphorus level after 3 months.

RESULTS

At baseline, there was no significant difference in serum phosphorus levels between the 2 groups. After 3 months, the decline in serum phosphorus levels was 0.6 mg/dL larger among intervention vs control participants (95% confidence interval, -1.0 to -0.1 mg/dL). Intervention participants also had statistically significant increases in reading ingredient lists (P<.001) and nutrition facts labels (P = .04) but no significant increase in food knowledge scores (P = .13).

CONCLUSION

Educating end-stage renal disease patients to avoid phosphorus-containing food additives resulted in modest improvements in hyperphosphatemia.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00583570.

Authors+Show Affiliations

Division of Nephrology, MetroHealth Medical Center, 2500 MetroHealth Dr, Cleveland, OH 44109, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19211470

Citation

Sullivan, Catherine, et al. "Effect of Food Additives On Hyperphosphatemia Among Patients With End-stage Renal Disease: a Randomized Controlled Trial." JAMA, vol. 301, no. 6, 2009, pp. 629-35.
Sullivan C, Sayre SS, Leon JB, et al. Effect of food additives on hyperphosphatemia among patients with end-stage renal disease: a randomized controlled trial. JAMA. 2009;301(6):629-35.
Sullivan, C., Sayre, S. S., Leon, J. B., Machekano, R., Love, T. E., Porter, D., Marbury, M., & Sehgal, A. R. (2009). Effect of food additives on hyperphosphatemia among patients with end-stage renal disease: a randomized controlled trial. JAMA, 301(6), 629-35. https://doi.org/10.1001/jama.2009.96
Sullivan C, et al. Effect of Food Additives On Hyperphosphatemia Among Patients With End-stage Renal Disease: a Randomized Controlled Trial. JAMA. 2009 Feb 11;301(6):629-35. PubMed PMID: 19211470.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of food additives on hyperphosphatemia among patients with end-stage renal disease: a randomized controlled trial. AU - Sullivan,Catherine, AU - Sayre,Srilekha S, AU - Leon,Janeen B, AU - Machekano,Rhoderick, AU - Love,Thomas E, AU - Porter,David, AU - Marbury,Marquisha, AU - Sehgal,Ashwini R, PY - 2009/2/13/entrez PY - 2009/2/13/pubmed PY - 2009/2/20/medline SP - 629 EP - 35 JF - JAMA JO - JAMA VL - 301 IS - 6 N2 - CONTEXT: High dietary phosphorus intake has deleterious consequences for renal patients and is possibly harmful for the general public as well. To prevent hyperphosphatemia, patients with end-stage renal disease limit their intake of foods that are naturally high in phosphorus. However, phosphorus-containing additives are increasingly being added to processed and fast foods. The effect of such additives on serum phosphorus levels is unclear. OBJECTIVE: To determine the effect of limiting the intake of phosphorus-containing food additives on serum phosphorus levels among patients with end-stage renal disease. DESIGN, SETTING, AND PARTICIPANTS: Cluster randomized controlled trial at 14 long-term hemodialysis facilities in northeast Ohio. Two hundred seventy-nine patients with elevated baseline serum phosphorus levels (>5.5 mg/dL) were recruited between May and October 2007. Two shifts at each of 12 large facilities and 1 shift at each of 2 small facilities were randomly assigned to an intervention or control group. INTERVENTION: Intervention participants (n=145) received education on avoiding foods with phosphorus additives when purchasing groceries or visiting fast food restaurants. Control participants (n=134) continued to receive usual care. MAIN OUTCOME MEASURE: Change in serum phosphorus level after 3 months. RESULTS: At baseline, there was no significant difference in serum phosphorus levels between the 2 groups. After 3 months, the decline in serum phosphorus levels was 0.6 mg/dL larger among intervention vs control participants (95% confidence interval, -1.0 to -0.1 mg/dL). Intervention participants also had statistically significant increases in reading ingredient lists (P<.001) and nutrition facts labels (P = .04) but no significant increase in food knowledge scores (P = .13). CONCLUSION: Educating end-stage renal disease patients to avoid phosphorus-containing food additives resulted in modest improvements in hyperphosphatemia. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00583570. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/19211470/Effect_of_food_additives_on_hyperphosphatemia_among_patients_with_end_stage_renal_disease:_a_randomized_controlled_trial_ DB - PRIME DP - Unbound Medicine ER -