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Journal of Nutrition Research
An official journal of IAPEN India association

Article

Association of Dietary Phosphorus Intake with Serum Phosphate: An Observational Study in Maintenance of Hemodialysis Patients
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Journal of Nutrition Research

DOI: 10.55289/jnutres/v10i1_22.8

Year: 2022, Volume: 10, Issue: 1, Pages: 11-19

Original Article

Association of Dietary Phosphorus Intake with Serum Phosphate: An Observational Study in Maintenance of Hemodialysis Patients

Jyotsna Puthran 1 , Reena Alex​ ✉ 2

1 Principal Investigator, RD, Mumbai, Maharashtra, India
2 Co-­investigator, RD, Mumbai, Maharashtra, India

Corresponding author ✉: [email protected]

Received Date:26 May 2022, Accepted Date:21 December 2022, Published Date:26 December 2022

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Hyperphosphatemia increases mortality in chronic kidney disease (CKD) patients on maintenance hemodialysis (MHD). Hyperphosphatemia in MHD patients is affected by diet and phosphate binders treatment. Thus, we undertook observational research to determine how dietary phosphorus consumption and phosphate binders adherence affect serum phosphate and phosphorus-to-protein ratio (PPR) in MHD. Associations of serum phosphate were examined with identified dietary patterns, organic (plant and animal-based) and inorganic, and whether the patients fully or partially adhered to the phosphate binders. We found a significant difference in phosphate binders on animal and plant sources, high with the animal pattern. However, our study showed no significant correlation in serum phosphate levels. This result could be due to phosphate bioavailability differing by food source and adherence of phosphate binders, which reflect the quantity of phosphate absorbed in the intestines. However, further mechanistic study is warranted.

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Keywords: Dietary phosphorus, Maintenance hemodialysis, Serum phosphate, Phosphorus­to­protein ratio

References

  1. Yamada S, Tsuruya K, Taniguchi M, Tokumoto M, Fujisaki K, Hirakata H, et al. Association Between Serum Phosphate Levels and Stroke Risk in Patients Undergoing Hemodialysis. Stroke. 2016;47(9):2189–2196. Available from: https://doi.org/10.1161/STROKEAHA.116.013195
  3. Sullivan C, Sayre SS, Leon JB, Machekano R, Love TE, Porter D, et al. Effect of Food Additives on Hyperphosphatemia Among Patients With End-stage Renal Disease. JAMA. 2009;301(6):629–635. Available from: https://doi.org/10.1001/jama.2009.96
  5. Foley RN, Collins AJ, Ishani A, Kalra PA. Calcium-phosphate levels and cardiovascular disease in community-dwelling adults: The Atherosclerosis Risk in Communities (ARIC) Study. American Heart Journal. 2008;156(3):556–563. Available from: https://pubmed.ncbi.nlm.nih.gov/18760141/
  6. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Kidney International Suppl.. 2009;113:1–130. Available from: https://doi.org/10.1038/ki.2009.188
  7. Stremke ER, Mccabe LD, Mccabe GP, Martin BR, Moe SM, Weaver CM, et al. Twenty-Four-Hour Urine Phosphorus as a Biomarker of Dietary Phosphorus Intake and Absorption in CKD. Clinical Journal of the American Society of Nephrology. 2018;13(7):1002–1012. Available from: https://pubmed.ncbi.nlm.nih.gov/29921736/
  8. Waheed AA, Pedraza F, Lenz O, Isakova T. Phosphate control in end-stage renal disease: barriers and opportunities. Nephrology Dialysis Transplantation. 2013;28(12):2961–2968. Available from: https://pubmed.ncbi.nlm.nih.gov/23901051/
  9. Rastogi A, Bhatt N, Rossetti S, Beto J. Management of Hyperphosphatemia in End-Stage Renal Disease: A New Paradigm. Journal of Renal Nutrition. 2021;31(1):21–34. Available from: https://jamanetwork.com/journals/jama/article-abstract/326375
  10. González-Parra E, Gracia-Iguacel C, Egido J, Ortiz A. Phosphorus and Nutrition in Chronic Kidney Disease. International Journal of Nephrology. 2012;2012:1–5. Available from: https://pubmed.ncbi.nlm.nih.gov/22701173/
  11. Perlmutter M. URINE-SERUM UREA NITROGEN RATIO. Journal of the American Medical Association. 1959;170(13):1533–1537. Available from: https://jamanetwork.com/journals/jama/article-abstract/326375
  12. Mier MVPRD, Vergara N, Rodelo-Haad C, López-Zamorano MD, Membrives-González C, López-Baltanás R, et al. Assessment of Inorganic Phosphate Intake by the Measurement of the Phosphate/Urea Nitrogen Ratio in Urine. Nutrients. 2021;13(2):292. Available from: https://doi.org/10.3390/nu13020292
  13. Lynch KE, Lynch RE, Curhan GC, Brunelli SM. Prescribed Dietary Phosphate Restriction and Survival among Hemodialysis Patients. Clinical Journal of the American Society of Nephrology. 2011;6(3):620–629. Available from: https://pubmed.ncbi.nlm.nih.gov/21148246/
  14. Anderson CAM, Nguyen HA, Rifkin DE. Nutrition Interventions in Chronic Kidney Disease. Medical Clinics of North America. 2016;100(6):1265–1283. Available from: https://pubmed.ncbi.nlm.nih.gov/27745594/
  15. Mehrotra R, Kermah D, Fried L, Kalantar-Zadeh K, Khawar O, Norris K, et al. Chronic Peritoneal Dialysis in the United States: Declining Utilization Despite Improving Outcomes. Journal of the American Society of Nephrology. 2007;18(10):2781–2788. Available from: https://pubmed.ncbi.nlm.nih.gov/17804675/
  16. Beddhu S, Bruns FJ, Saul M, Seddon P, Zeidel ML. A simple comorbidity scale predicts clinical outcomes and costs in dialysis patients. The American Journal of Medicine. 2000;108(8):609–613. Available from: https://pubmed.ncbi.nlm.nih.gov/10856407/
  17. Khor BH, Sualeheen A, Sahathevan S, Chinna K, Gafor AHA, Bavanandan S, et al. Association of dietary patterns with serum phosphorus in maintenance haemodialysis patients: a cross-sectional study. Scientific Reports. 2020;10(1):12278. Available from: https://europepmc.org/article/pmc/7378243
  18. Kalantar-Zadeh K, Gutekunst L, Mehrotra R, Kovesdy CP, Bross R, Shinaberger CS, et al. Understanding Sources of Dietary Phosphorus in the Treatment of Patients with Chronic Kidney Disease. Clinical Journal of the American Society of Nephrology. 2010;5(3):519–530. Available from: https://doi.org/10.2215/cjn.06080809
  19. Navarro-Alarcon M, Zambrano E, Moreno-Montoro M, Agil A, Olalla M. Duplicate portion sampling combined with spectrophotometric analysis affords the most accurate results when assessing daily dietary phosphorus intake. Nutrition Research. 2012;32(8):573–580. Available from: https://doi.org/10.1016/j.nutres.2012.06.013
  20. St-Jules DE, Woolf K, Pompeii ML, Kalantar-Zadeh K, Sevick MA. Reexamining the Phosphorus–Protein Dilemma: Does Phosphorus Restriction Compromise Protein Status? Journal of Renal Nutrition. 2016;26(3):136–140. Available from: https://pubmed.ncbi.nlm.nih.gov/27810171/
  21. Nelson SML, Sarabia SRS, Christilaw E, Ward EC, Lynch SK, Adams MA, et al. Phosphate-Containing Prescription Medications Contribute to the Daily Phosphate Intake in a Third of Hemodialysis Patients. Journal of Renal Nutrition. 2017;27(2):91–96. Available from: https://pubmed.ncbi.nlm.nih.gov/27814946/
  22. Watanabe MT, Araujo RM, Vogt BP, Barretti P, Caramori JCT. Most consumed processed foods by patients on hemodialysis: Alert for phosphate-containing additives and the phosphate-to-protein ratio. Clinical Nutrition ESPEN. 2016;14:37–41. Available from: https://pubmed.ncbi.nlm.nih.gov/28531397/
  24. Uribarri J, Calvo MS. Hidden Sources of Phosphorus in the Typical American Diet: Does it Matter in Nephrology? Seminars in Dialysis. 2003;16(3):186–188. Available from: https://pubmed.ncbi.nlm.nih.gov/12753675/
  25. St-Jules DE, Jagannathan R, Gutekunst L, Kalantar-Zadeh K, Sevick MA. Examining the Proportion of Dietary Phosphorus From Plants, Animals, and Food Additives Excreted in Urine. Journal of Renal Nutrition. 2017;27(2):78–83. Available from: https://pubmed.ncbi.nlm.nih.gov/27810171/
  26. Karp H, Ekholm P, Kemi V, Itkonen S, Hirvonen T, Närkki S, et al. Differences Among Total and In Vitro Digestible Phosphorus Content of Plant Foods and Beverages. Journal of Renal Nutrition. 2012;22(4):416–422. Available from: https://pubmed.ncbi.nlm.nih.gov/21741857/
  27. Benini O, D’alessandro C, Gianfaldoni D, Cupisti A. Extra-Phosphate Load From Food Additives in Commonly Eaten Foods: A Real and Insidious Danger for Renal Patients. Journal of Renal Nutrition. 2011;21(4):303–308. Available from: https://pubmed.ncbi.nlm.nih.gov/21055967/

Copyright

© 2022 Puthran & Alex. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Published By India Association for Parenteral and Enteral Nutrition (IAPEN)

  • 26 December 2022

Year: 2022, Volume: 10, Issue: 1


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