Organic and inorganic dietary phosphorus and its management in chronic kidney disease

Nazanin Noori, John J. Sims, Joel D. Kopple, Anuja Shah, Sara Colman, Christian S. Shinaberger, Rachelle Bross, Rajnish Mehrotra, Csaba Kovesdy, Kamyar Kalantar-Zadeh

Research output: Contribution to journalReview article

56 Citations (Scopus)

Abstract

Dietary phosphorus control is often a main strategy in the management of patients with chronic kidney disease. Dietary protein is a major source of phosphorus intake. Recent data indicate that imposed dietary phosphorus restriction may compromise the need for adequate protein intake, leading to protein-energy wasting and possibly to increased mortality. The two main sources of dietary phosphorus are organic, including animal and vegetarian proteins, and inorganic, mostly food preservatives. Animal-based foods and plant are abundant in organic phosphorus. Usually 40% to 60% of animal-based phosphorus is absorbed; this varies by degree of gastrointestinal vitamin-D-receptor activation, whereas plant phosphorus, mostly associated with phytates, is less absorbable by human gastrointestinal tract. Up to 100% of inorganic phosphorus in processed foods may be absorbed; ie, phosphorus in processed cheese and some soda (cola) drinks. A recent study suggests that a higher dietary phosphorus-protein intake ratio is associated with incremental death risk in patients on long-term hemodialysis. Hence, for phosphorus management in chronic kidney disease, in addition to absolute dietary phosphorus content, the chemical structure (inorganic versus organic), type (animal versus plant), and phosphorus-protein ratio should be considered. We recommend foods and supplements with no or lowest quantity of inorganic phosphorus additives, more plant-based proteins, and a dietary phosphorus-protein ratio of less than 10 mg/g. Fresh (nonprocessed) egg white (phosphorus-protein ratio less than 2 mg/g) is a good example of desirable food, which contains a high proportion of essential amino acids with low amounts of fat, cholesterol, and phosphorus.

Original languageEnglish (US)
Pages (from-to)89-100
Number of pages12
JournalIranian Journal of Kidney Diseases
Volume4
Issue number2
StatePublished - Apr 1 2010
Externally publishedYes

Fingerprint

Dietary Phosphorus
Chronic Renal Insufficiency
Phosphorus
Dietary Proteins
Plant Proteins
Inorganic Chemicals
Food Preservatives
Egg Proteins
Food
Edible Plants
Phytic Acid
Calcitriol Receptors
Proteins
Essential Amino Acids
Cheese
Dietary Supplements
Renal Dialysis
Gastrointestinal Tract

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Noori, N., Sims, J. J., Kopple, J. D., Shah, A., Colman, S., Shinaberger, C. S., ... Kalantar-Zadeh, K. (2010). Organic and inorganic dietary phosphorus and its management in chronic kidney disease. Iranian Journal of Kidney Diseases, 4(2), 89-100.

Organic and inorganic dietary phosphorus and its management in chronic kidney disease. / Noori, Nazanin; Sims, John J.; Kopple, Joel D.; Shah, Anuja; Colman, Sara; Shinaberger, Christian S.; Bross, Rachelle; Mehrotra, Rajnish; Kovesdy, Csaba; Kalantar-Zadeh, Kamyar.

In: Iranian Journal of Kidney Diseases, Vol. 4, No. 2, 01.04.2010, p. 89-100.

Research output: Contribution to journalReview article

Noori, N, Sims, JJ, Kopple, JD, Shah, A, Colman, S, Shinaberger, CS, Bross, R, Mehrotra, R, Kovesdy, C & Kalantar-Zadeh, K 2010, 'Organic and inorganic dietary phosphorus and its management in chronic kidney disease', Iranian Journal of Kidney Diseases, vol. 4, no. 2, pp. 89-100.
Noori N, Sims JJ, Kopple JD, Shah A, Colman S, Shinaberger CS et al. Organic and inorganic dietary phosphorus and its management in chronic kidney disease. Iranian Journal of Kidney Diseases. 2010 Apr 1;4(2):89-100.
Noori, Nazanin ; Sims, John J. ; Kopple, Joel D. ; Shah, Anuja ; Colman, Sara ; Shinaberger, Christian S. ; Bross, Rachelle ; Mehrotra, Rajnish ; Kovesdy, Csaba ; Kalantar-Zadeh, Kamyar. / Organic and inorganic dietary phosphorus and its management in chronic kidney disease. In: Iranian Journal of Kidney Diseases. 2010 ; Vol. 4, No. 2. pp. 89-100.
@article{712c0f6f5d1144c78b447d245cdd8bb4,
title = "Organic and inorganic dietary phosphorus and its management in chronic kidney disease",
abstract = "Dietary phosphorus control is often a main strategy in the management of patients with chronic kidney disease. Dietary protein is a major source of phosphorus intake. Recent data indicate that imposed dietary phosphorus restriction may compromise the need for adequate protein intake, leading to protein-energy wasting and possibly to increased mortality. The two main sources of dietary phosphorus are organic, including animal and vegetarian proteins, and inorganic, mostly food preservatives. Animal-based foods and plant are abundant in organic phosphorus. Usually 40{\%} to 60{\%} of animal-based phosphorus is absorbed; this varies by degree of gastrointestinal vitamin-D-receptor activation, whereas plant phosphorus, mostly associated with phytates, is less absorbable by human gastrointestinal tract. Up to 100{\%} of inorganic phosphorus in processed foods may be absorbed; ie, phosphorus in processed cheese and some soda (cola) drinks. A recent study suggests that a higher dietary phosphorus-protein intake ratio is associated with incremental death risk in patients on long-term hemodialysis. Hence, for phosphorus management in chronic kidney disease, in addition to absolute dietary phosphorus content, the chemical structure (inorganic versus organic), type (animal versus plant), and phosphorus-protein ratio should be considered. We recommend foods and supplements with no or lowest quantity of inorganic phosphorus additives, more plant-based proteins, and a dietary phosphorus-protein ratio of less than 10 mg/g. Fresh (nonprocessed) egg white (phosphorus-protein ratio less than 2 mg/g) is a good example of desirable food, which contains a high proportion of essential amino acids with low amounts of fat, cholesterol, and phosphorus.",
author = "Nazanin Noori and Sims, {John J.} and Kopple, {Joel D.} and Anuja Shah and Sara Colman and Shinaberger, {Christian S.} and Rachelle Bross and Rajnish Mehrotra and Csaba Kovesdy and Kamyar Kalantar-Zadeh",
year = "2010",
month = "4",
day = "1",
language = "English (US)",
volume = "4",
pages = "89--100",
journal = "Iranian Journal of Kidney Diseases",
issn = "1735-8582",
publisher = "Iranian Society of Nephrology",
number = "2",

}

TY - JOUR

T1 - Organic and inorganic dietary phosphorus and its management in chronic kidney disease

AU - Noori, Nazanin

AU - Sims, John J.

AU - Kopple, Joel D.

AU - Shah, Anuja

AU - Colman, Sara

AU - Shinaberger, Christian S.

AU - Bross, Rachelle

AU - Mehrotra, Rajnish

AU - Kovesdy, Csaba

AU - Kalantar-Zadeh, Kamyar

PY - 2010/4/1

Y1 - 2010/4/1

N2 - Dietary phosphorus control is often a main strategy in the management of patients with chronic kidney disease. Dietary protein is a major source of phosphorus intake. Recent data indicate that imposed dietary phosphorus restriction may compromise the need for adequate protein intake, leading to protein-energy wasting and possibly to increased mortality. The two main sources of dietary phosphorus are organic, including animal and vegetarian proteins, and inorganic, mostly food preservatives. Animal-based foods and plant are abundant in organic phosphorus. Usually 40% to 60% of animal-based phosphorus is absorbed; this varies by degree of gastrointestinal vitamin-D-receptor activation, whereas plant phosphorus, mostly associated with phytates, is less absorbable by human gastrointestinal tract. Up to 100% of inorganic phosphorus in processed foods may be absorbed; ie, phosphorus in processed cheese and some soda (cola) drinks. A recent study suggests that a higher dietary phosphorus-protein intake ratio is associated with incremental death risk in patients on long-term hemodialysis. Hence, for phosphorus management in chronic kidney disease, in addition to absolute dietary phosphorus content, the chemical structure (inorganic versus organic), type (animal versus plant), and phosphorus-protein ratio should be considered. We recommend foods and supplements with no or lowest quantity of inorganic phosphorus additives, more plant-based proteins, and a dietary phosphorus-protein ratio of less than 10 mg/g. Fresh (nonprocessed) egg white (phosphorus-protein ratio less than 2 mg/g) is a good example of desirable food, which contains a high proportion of essential amino acids with low amounts of fat, cholesterol, and phosphorus.

AB - Dietary phosphorus control is often a main strategy in the management of patients with chronic kidney disease. Dietary protein is a major source of phosphorus intake. Recent data indicate that imposed dietary phosphorus restriction may compromise the need for adequate protein intake, leading to protein-energy wasting and possibly to increased mortality. The two main sources of dietary phosphorus are organic, including animal and vegetarian proteins, and inorganic, mostly food preservatives. Animal-based foods and plant are abundant in organic phosphorus. Usually 40% to 60% of animal-based phosphorus is absorbed; this varies by degree of gastrointestinal vitamin-D-receptor activation, whereas plant phosphorus, mostly associated with phytates, is less absorbable by human gastrointestinal tract. Up to 100% of inorganic phosphorus in processed foods may be absorbed; ie, phosphorus in processed cheese and some soda (cola) drinks. A recent study suggests that a higher dietary phosphorus-protein intake ratio is associated with incremental death risk in patients on long-term hemodialysis. Hence, for phosphorus management in chronic kidney disease, in addition to absolute dietary phosphorus content, the chemical structure (inorganic versus organic), type (animal versus plant), and phosphorus-protein ratio should be considered. We recommend foods and supplements with no or lowest quantity of inorganic phosphorus additives, more plant-based proteins, and a dietary phosphorus-protein ratio of less than 10 mg/g. Fresh (nonprocessed) egg white (phosphorus-protein ratio less than 2 mg/g) is a good example of desirable food, which contains a high proportion of essential amino acids with low amounts of fat, cholesterol, and phosphorus.

UR - http://www.scopus.com/inward/record.url?scp=77953164325&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77953164325&partnerID=8YFLogxK

M3 - Review article

VL - 4

SP - 89

EP - 100

JO - Iranian Journal of Kidney Diseases

JF - Iranian Journal of Kidney Diseases

SN - 1735-8582

IS - 2

ER -