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Balancing nutrition and serum phosphorus in maintenance dialysis.
Am J Kidney Dis. 2014 Jul; 64(1):143-50.AJ

Abstract

Elevated serum phosphorus levels are common in patients with chronic kidney disease and are associated with heart and vascular disease, conditions that in turn are associated with increased mortality. Accurately managing phosphorus intake by restricting dietary protein alone can prove challenging because protein from different sources can contain varying amounts of available phosphorus. Additives used in processed foods frequently are high in inorganic phosphorus, which is readily absorbed, compounding this difficulty. Recent evidence suggests that dietary protein restriction in some cases may do more harm than good in some patients treated with maintenance hemodialysis because protein restriction can lead to protein-energy wasting, which is associated with increased mortality. Accordingly, phosphorus binders are important for managing hyperphosphatemia in dialysis patients. Managing hyperphosphatemia in patients with late-stage chronic kidney disease requires an individualized approach, involving a combination of adequate dietary advice, phosphate-binder use, and adjustments to dialysis prescription. We speculate that increased use of phosphate binders could allow patients to eat more protein-rich foods and that communicating this to patients might increase their perception of their need for phosphate binders, providing an incentive to improve adherence. The aim of this review is to discuss the challenges involved in maintaining adequate nutrition while controlling phosphorus levels in patients on maintenance hemodialysis therapy.

Authors+Show Affiliations

Department of Nephrology, Centre Hospitalier Lyon Sud, CENS and Université de Lyon, Lyon, France. Electronic address: denis.fouque@chu-lyon.fr.The UCL School of Pharmacy, University College London, London, United Kingdom.Department of Health Sciences, Renal Division, Hospital San Paolo, University of Milan, Italy.UCLA David Geffen School of Medicine and UCLA School of Public Health, Harold Simmons Center for Chronic Disease Research and Epidemiology, Harbor-UCLA Medical Center, Torrance, CA; Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA.

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

24819675

Citation

Fouque, Denis, et al. "Balancing Nutrition and Serum Phosphorus in Maintenance Dialysis." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 64, no. 1, 2014, pp. 143-50.
Fouque D, Horne R, Cozzolino M, et al. Balancing nutrition and serum phosphorus in maintenance dialysis. Am J Kidney Dis. 2014;64(1):143-50.
Fouque, D., Horne, R., Cozzolino, M., & Kalantar-Zadeh, K. (2014). Balancing nutrition and serum phosphorus in maintenance dialysis. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 64(1), 143-50. https://doi.org/10.1053/j.ajkd.2014.01.429
Fouque D, et al. Balancing Nutrition and Serum Phosphorus in Maintenance Dialysis. Am J Kidney Dis. 2014;64(1):143-50. PubMed PMID: 24819675.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Balancing nutrition and serum phosphorus in maintenance dialysis. AU - Fouque,Denis, AU - Horne,Rob, AU - Cozzolino,Mario, AU - Kalantar-Zadeh,Kamyar, Y1 - 2014/03/12/ PY - 2013/05/06/received PY - 2014/01/14/accepted PY - 2014/5/14/entrez PY - 2014/5/14/pubmed PY - 2014/10/1/medline KW - Diet, protein-restricted KW - chronic kidney disease KW - phosphate binders KW - phosphorus, dietary SP - 143 EP - 50 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 64 IS - 1 N2 - Elevated serum phosphorus levels are common in patients with chronic kidney disease and are associated with heart and vascular disease, conditions that in turn are associated with increased mortality. Accurately managing phosphorus intake by restricting dietary protein alone can prove challenging because protein from different sources can contain varying amounts of available phosphorus. Additives used in processed foods frequently are high in inorganic phosphorus, which is readily absorbed, compounding this difficulty. Recent evidence suggests that dietary protein restriction in some cases may do more harm than good in some patients treated with maintenance hemodialysis because protein restriction can lead to protein-energy wasting, which is associated with increased mortality. Accordingly, phosphorus binders are important for managing hyperphosphatemia in dialysis patients. Managing hyperphosphatemia in patients with late-stage chronic kidney disease requires an individualized approach, involving a combination of adequate dietary advice, phosphate-binder use, and adjustments to dialysis prescription. We speculate that increased use of phosphate binders could allow patients to eat more protein-rich foods and that communicating this to patients might increase their perception of their need for phosphate binders, providing an incentive to improve adherence. The aim of this review is to discuss the challenges involved in maintaining adequate nutrition while controlling phosphorus levels in patients on maintenance hemodialysis therapy. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/24819675/Balancing_nutrition_and_serum_phosphorus_in_maintenance_dialysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(14)00523-X DB - PRIME DP - Unbound Medicine ER -