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Is it possible to control hyperphosphataemia with diet, without inducing protein malnutrition?

Abstract

Dietary intervention, phosphate (P) removal during dialysis and, especially, phosphate binders are current methods for the management of hyperphosphataemia. Ideally, the amount of P absorbed from the diet should equal the amount of P removed during dialysis, and this must occur in the context of an adequate protein intake. We evaluated the relationship between P intake and protein intake in 60 stable chronic uraemic patients (mean age 55+/-15 years, 25% diabetics, 68% males) on standard 4 h haemodialysis. The dietary counselling was relatively free for protein and calories. Nutrient intake was recorded during a 5 day period, and average daily ingestion of P and proteins was calculated using a computerized diet analysis system. A highly significant correlation was observed between protein and P intake. The mean daily ingestion of P and proteins was 998+/-316 mg and 64+/-19 g (1+/-0.4 g/kg/day), respectively. For an optimal protein diet of 1-1.2 g/kg/day, the P intake was 778-1444 mg. The amount of P removed by haemodialysis, extrapolated to an average week, is 250-300 mg/day. Since approximately 40% of P ingested is absorbed from the gut by uraemic patients treated with intestinal P binders, 750 mg of P intake should be the critical value above which a positive balance of P may occur. This value corresponds to a protein intake of 45-50 g per day (>0.8 g/kg body weight/day for a 60 kg patient). In patients undergoing standard chronic haemodialysis, a neutral P balance is difficult to achieve, despite phosphate binder therapy, when protein intake is >50 g. Additional protein restriction, in order to obtain a neutral balance, may impose the risk of protein malnutrition.

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  • Authors+Show Affiliations

    ,

    Nephrology Service, Hospital Universitario Canarias, Santa Cruz de Tenerife, Spain.

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    MeSH

    Adult
    Aged
    Aged, 80 and over
    Cross-Sectional Studies
    Dietary Proteins
    Female
    Humans
    Male
    Middle Aged
    Phosphorus
    Phosphorus, Dietary
    Protein Deficiency
    Renal Dialysis

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    9568824

    Citation

    Rufino, M, et al. "Is It Possible to Control Hyperphosphataemia With Diet, Without Inducing Protein Malnutrition?" Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 13 Suppl 3, 1998, pp. 65-7.
    Rufino M, de Bonis E, Martín M, et al. Is it possible to control hyperphosphataemia with diet, without inducing protein malnutrition? Nephrol Dial Transplant. 1998;13 Suppl 3:65-7.
    Rufino, M., de Bonis, E., Martín, M., Rebollo, S., Martín, B., Miquel, R., ... Lorenzo, V. (1998). Is it possible to control hyperphosphataemia with diet, without inducing protein malnutrition? Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 13 Suppl 3, pp. 65-7.
    Rufino M, et al. Is It Possible to Control Hyperphosphataemia With Diet, Without Inducing Protein Malnutrition. Nephrol Dial Transplant. 1998;13 Suppl 3:65-7. PubMed PMID: 9568824.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Is it possible to control hyperphosphataemia with diet, without inducing protein malnutrition? AU - Rufino,M, AU - de Bonis,E, AU - Martín,M, AU - Rebollo,S, AU - Martín,B, AU - Miquel,R, AU - Cobo,M, AU - Hernández,D, AU - Torres,A, AU - Lorenzo,V, PY - 1998/5/6/pubmed PY - 1998/5/6/medline PY - 1998/5/6/entrez SP - 65 EP - 7 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol. Dial. Transplant. VL - 13 Suppl 3 N2 - Dietary intervention, phosphate (P) removal during dialysis and, especially, phosphate binders are current methods for the management of hyperphosphataemia. Ideally, the amount of P absorbed from the diet should equal the amount of P removed during dialysis, and this must occur in the context of an adequate protein intake. We evaluated the relationship between P intake and protein intake in 60 stable chronic uraemic patients (mean age 55+/-15 years, 25% diabetics, 68% males) on standard 4 h haemodialysis. The dietary counselling was relatively free for protein and calories. Nutrient intake was recorded during a 5 day period, and average daily ingestion of P and proteins was calculated using a computerized diet analysis system. A highly significant correlation was observed between protein and P intake. The mean daily ingestion of P and proteins was 998+/-316 mg and 64+/-19 g (1+/-0.4 g/kg/day), respectively. For an optimal protein diet of 1-1.2 g/kg/day, the P intake was 778-1444 mg. The amount of P removed by haemodialysis, extrapolated to an average week, is 250-300 mg/day. Since approximately 40% of P ingested is absorbed from the gut by uraemic patients treated with intestinal P binders, 750 mg of P intake should be the critical value above which a positive balance of P may occur. This value corresponds to a protein intake of 45-50 g per day (>0.8 g/kg body weight/day for a 60 kg patient). In patients undergoing standard chronic haemodialysis, a neutral P balance is difficult to achieve, despite phosphate binder therapy, when protein intake is >50 g. Additional protein restriction, in order to obtain a neutral balance, may impose the risk of protein malnutrition. SN - 0931-0509 UR - https://www.unboundmedicine.com/medline/citation/9568824/full_citation L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/13.suppl_3.65 DB - PRIME DP - Unbound Medicine ER -