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Dietary phosphorus restriction in advanced chronic kidney disease: merits, challenges, and emerging strategies.
Semin Dial. 2010 Jul-Aug; 23(4):401-6.SD

Abstract

Hyperphosphatemia is an independent risk factor for mortality in patients on maintenance dialysis. Since phosphorus clearance by standard three times-weekly dialysis is insufficient to balance ongoing dietary phosphorus intake, strategies to prevent absorption of dietary phosphorus are essential for attenuating increased serum levels. Dietary phosphorus binders are used widely for this purpose but dietary phosphorus restriction is relatively underutilized, most likely because of the logistical complexity of instituting and monitoring a low phosphorus diet, and for fear of worsening protein-energy wasting, which itself is a potent risk factor for mortality. In this review, we propose sustainable strategies for reducing phosphorus intake while avoiding exacerbation of protein-energy wasting. The approach is based on recognition of the dissociation between protein and phosphorus content in phosphorus-rich processed foods and the varying phosphorus bioavailability in different dietary sources. Controlling serum phosphate levels is among the most challenging aspects of day-to-day dialysis care but integration of sensible dietary interventions will likely improve phosphorus control.

Authors+Show Affiliations

Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

20557490

Citation

Gutiérrez, Orlando M., and Myles Wolf. "Dietary Phosphorus Restriction in Advanced Chronic Kidney Disease: Merits, Challenges, and Emerging Strategies." Seminars in Dialysis, vol. 23, no. 4, 2010, pp. 401-6.
Gutiérrez OM, Wolf M. Dietary phosphorus restriction in advanced chronic kidney disease: merits, challenges, and emerging strategies. Semin Dial. 2010;23(4):401-6.
Gutiérrez, O. M., & Wolf, M. (2010). Dietary phosphorus restriction in advanced chronic kidney disease: merits, challenges, and emerging strategies. Seminars in Dialysis, 23(4), 401-6. https://doi.org/10.1111/j.1525-139X.2010.00750.x
Gutiérrez OM, Wolf M. Dietary Phosphorus Restriction in Advanced Chronic Kidney Disease: Merits, Challenges, and Emerging Strategies. Semin Dial. 2010 Jul-Aug;23(4):401-6. PubMed PMID: 20557490.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dietary phosphorus restriction in advanced chronic kidney disease: merits, challenges, and emerging strategies. AU - Gutiérrez,Orlando M, AU - Wolf,Myles, Y1 - 2010/06/14/ PY - 2010/6/19/entrez PY - 2010/6/19/pubmed PY - 2010/12/22/medline SP - 401 EP - 6 JF - Seminars in dialysis JO - Semin Dial VL - 23 IS - 4 N2 - Hyperphosphatemia is an independent risk factor for mortality in patients on maintenance dialysis. Since phosphorus clearance by standard three times-weekly dialysis is insufficient to balance ongoing dietary phosphorus intake, strategies to prevent absorption of dietary phosphorus are essential for attenuating increased serum levels. Dietary phosphorus binders are used widely for this purpose but dietary phosphorus restriction is relatively underutilized, most likely because of the logistical complexity of instituting and monitoring a low phosphorus diet, and for fear of worsening protein-energy wasting, which itself is a potent risk factor for mortality. In this review, we propose sustainable strategies for reducing phosphorus intake while avoiding exacerbation of protein-energy wasting. The approach is based on recognition of the dissociation between protein and phosphorus content in phosphorus-rich processed foods and the varying phosphorus bioavailability in different dietary sources. Controlling serum phosphate levels is among the most challenging aspects of day-to-day dialysis care but integration of sensible dietary interventions will likely improve phosphorus control. SN - 1525-139X UR - https://www.unboundmedicine.com/medline/citation/20557490/Dietary_phosphorus_restriction_in_advanced_chronic_kidney_disease:_merits_challenges_and_emerging_strategies_ L2 - https://doi.org/10.1111/j.1525-139X.2010.00750.x DB - PRIME DP - Unbound Medicine ER -