Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease

Kamyar Kalantar-Zadeh, Lisa Gutekunst, Rajnish Mehrotra, Csaba Kovesdy, Rachelle Bross, Christian S. Shinaberger, Nazanin Noori, Raimund Hirschberg, Debbie Benner, Allen R. Nissenson, Joel D. Kopple

Research output: Contribution to journalReview article

230 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)519-530
Number of pages12
JournalClinical Journal of the American Society of Nephrology
Volume5
Issue number3
DOIs
StatePublished - Mar 1 2010

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Dietary Phosphorus
Chronic Renal Insufficiency
Food
Proteins
Dialysis
Vegetable Proteins
Chronic Kidney Disease-Mineral and Bone Disorder
Vascular Calcification
Therapeutics
Carbonated Beverages
Food Additives
Edible Plants
Phytic Acid
Dietary Proteins
Hyperparathyroidism
Fabaceae
Intestines
Observational Studies
Prescriptions
Meals

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease. / Kalantar-Zadeh, Kamyar; Gutekunst, Lisa; Mehrotra, Rajnish; Kovesdy, Csaba; Bross, Rachelle; Shinaberger, Christian S.; Noori, Nazanin; Hirschberg, Raimund; Benner, Debbie; Nissenson, Allen R.; Kopple, Joel D.

In: Clinical Journal of the American Society of Nephrology, Vol. 5, No. 3, 01.03.2010, p. 519-530.

Research output: Contribution to journalReview article

Kalantar-Zadeh, K, Gutekunst, L, Mehrotra, R, Kovesdy, C, Bross, R, Shinaberger, CS, Noori, N, Hirschberg, R, Benner, D, Nissenson, AR & Kopple, JD 2010, 'Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease', Clinical Journal of the American Society of Nephrology, vol. 5, no. 3, pp. 519-530. https://doi.org/10.2215/CJN.06080809
Kalantar-Zadeh, Kamyar ; Gutekunst, Lisa ; Mehrotra, Rajnish ; Kovesdy, Csaba ; Bross, Rachelle ; Shinaberger, Christian S. ; Noori, Nazanin ; Hirschberg, Raimund ; Benner, Debbie ; Nissenson, Allen R. ; Kopple, Joel D. / Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease. In: Clinical Journal of the American Society of Nephrology. 2010 ; Vol. 5, No. 3. pp. 519-530.
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