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Understanding Sources of Dietary Phosphorus in the Treatment of Patients with Chronic Kidney Disease

Kamyar Kalantar-Zadeh, Lisa Gutekunst, Rajnish Mehrotra, Csaba P. Kovesdy, Rachelle Bross, Christian S. Shinaberger, Nazanin Noori, Raimund Hirschberg, Debbie Benner, Allen R. Nissenson and Joel D. Kopple
CJASN March 2010, 5 (3) 519-530; DOI: https://doi.org/10.2215/CJN.06080809
Kamyar Kalantar-Zadeh
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Lisa Gutekunst
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Rajnish Mehrotra
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Csaba P. Kovesdy
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Rachelle Bross
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Christian S. Shinaberger
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Nazanin Noori
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Raimund Hirschberg
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Debbie Benner
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Allen R. Nissenson
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Joel D. Kopple
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Abstract

In individuals with chronic kidney disease, high dietary phosphorus (P) burden may worsen hyperparathyroidism and renal osteodystrophy, promote vascular calcification and cardiovascular events, and increase mortality. In addition to the absolute amount of dietary P, its type (organic versus inorganic), source (animal versus plant derived), and ratio to dietary protein may be important. Organic P in such plant foods as seeds and legumes is less bioavailable because of limited gastrointestinal absorption of phytate-based P. Inorganic P is more readily absorbed by intestine, and its presence in processed, preserved, or enhanced foods or soft drinks that contain additives may be underreported and not distinguished from the less readily absorbed organic P in nutrient databases. Hence, P burden from food additives is disproportionately high relative to its dietary content as compared with natural sources that are derived from organic (animal and vegetable) food proteins. Observational and metabolic studies indicate nutritional and longevity benefits of higher protein intake in dialysis patients. This presents challenges to providing appropriate nutrition because protein and P intakes are closely correlated. During dietary counseling of patients with chronic kidney disease, the absolute dietary P content as well as the P-to-protein ratio in foods should be addressed. Foods with the least amount of inorganic P, low P-to-protein ratios, and adequate protein content that are consistent with acceptable palatability and enjoyment to the individual patient should be recommended along with appropriate prescription of P binders. Provision of in-center and monitored meals during hemodialysis treatment sessions in the dialysis clinic may facilitate the achievement of these goals.

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    • Copyright © 2010 by the American Society of Nephrology
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    Clinical Journal of the American Society of Nephrology
    Vol. 5, Issue 3
    1 Mar 2010
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    Understanding Sources of Dietary Phosphorus in the Treatment of Patients with Chronic Kidney Disease
    Kamyar Kalantar-Zadeh, Lisa Gutekunst, Rajnish Mehrotra, Csaba P. Kovesdy, Rachelle Bross, Christian S. Shinaberger, Nazanin Noori, Raimund Hirschberg, Debbie Benner, Allen R. Nissenson, Joel D. Kopple
    CJASN Mar 2010, 5 (3) 519-530; DOI: 10.2215/CJN.06080809

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    Understanding Sources of Dietary Phosphorus in the Treatment of Patients with Chronic Kidney Disease
    Kamyar Kalantar-Zadeh, Lisa Gutekunst, Rajnish Mehrotra, Csaba P. Kovesdy, Rachelle Bross, Christian S. Shinaberger, Nazanin Noori, Raimund Hirschberg, Debbie Benner, Allen R. Nissenson, Joel D. Kopple
    CJASN Mar 2010, 5 (3) 519-530; DOI: 10.2215/CJN.06080809
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    • Article
      • Abstract
      • The Element Phosphorus
      • Dietary P and its Metabolism
      • Organic P and Dietary Protein
      • P Intake from Plant Foods: The Role of Phytate
      • Inorganic P in Additives
      • Implications of P Burden from Additives
      • Balancing Dietary Protein and P Intake in CKD
      • Metrics for Dietary P Management in CKD: P-to-Protein Ratio
      • Conclusions
      • Disclosures
      • Acknowledgments
      • Footnotes
      • References
    • Figures & Data Supps
    • Info & Metrics
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    More in this TOC Section

    • Assessing Physical Function and Physical Activity in Patients with CKD
    • Effect of Red Cell Transfusions on Future Kidney Transplantation
    • Management of Crush Victims in Mass Disasters: Highlights from Recently Published Recommendations
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    Cited By...

    • Dietary Therapy for Managing Hyperphosphatemia
    • Effect of Neighborhood Food Environment and Socioeconomic Status on Serum Phosphorus Level for Patients on Chronic Dialysis
    • The Effects of High-Protein Diets on Kidney Health and Longevity
    • Potassium Homeostasis, Chronic Kidney Disease, and the Plant-Enriched Diets
    • Elevated phosphate mediates extensive cellular toxicity: from abnormal proliferation to excessive cell death
    • Lack of Awareness of Dietary Sources of Phosphorus Is a Clinical Concern
    • Phosphorus binders: The new and the old, and how to choose
    • Phosphate Additive Avoidance in Chronic Kidney Disease
    • Nutrition in Cardioskeletal Health
    • Rationale and Approaches to Phosphate and Fibroblast Growth Factor 23 Reduction in CKD
    • Experimental and regional variations in Na+-dependent and Na+-independent phosphate transport along the rat small intestine and colon
    • Lower bioavailability of plant-derived phosphorus
    • Increasing Dietary Phosphorus Intake from Food Additives: Potential for Negative Impact on Bone Health
    • A Patient with CKD and Poor Nutritional Status
    • Effects of Phosphate Binders in Moderate CKD
    • Acute Effects of Very-Low-Protein Diet on FGF23 Levels: A Randomized Study
    • Effects of Dietary Phosphate and Calcium Intake on Fibroblast Growth Factor-23
    • Source Matters: From Phosphorus Load to Bioavailability
    • Low Socioeconomic Status Associates with Higher Serum Phosphate Irrespective of Race
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