D IETARY P HOSPHORUS A ND I TS E FFECT IN P ATIENTS WITH CKD Melanie Boney

S ERUM P HOSPHORUS Hyperphosphatemia CVD due to vascular calcification ↑ serum phosphorus levels associated with ↑ mortality CKD patients People without CKD

S ERUM P HOSPHORUS Treatments Phosphorus binders to decrease GI absorption Elimination via dialysis Dietary restriction

F OODS H IGH IN P HOSPHORUS Colas Dairy Seafood Nuts, Seeds & Legumes Cereal, whole wheat

F OODS H IGH IN P HOSPHORUS Processed Foods Cheeses Meats Salad Dressing Bakery Products Beverages

P HOSPHORUS A DDITIVES Extend product shelf life Improve color Enhance flavor Retain moisture Inorganic POrganic P Dicalcium PhosphatePhytic Acid Disodium PhosphatePhytate Monosodium Phosphate Phosphoric Acid Sodium Hexameta- Phosphate Sodium Tripoly phosphate Tetrasodium Pyro phosphate Trisodium Phosphate

ESRD KDOQI G UIDELINES Phosphorus restricted to mg/day When serum phosphorus levels are ≥5.5 mg/dL When plasma levels of PTH are >300 pg/mL Serum phosphorus levels should be monitored every month following the initiation of dietary phosphorus restriction

D IETARY P HOSPHORUS I NTAKE 1200 mg/ day = 8400 mg/week ~60% Absorbed Total to Remove ~5040 mg/week Dialysis 3000mg/week (1000 mg/session) Binders MUST Remove 2040 mg/week Increase by 300 mg/day = 10,500 mg/week 25% Increase = MORE BINDERS

C ONCLUSION

B EVERAGES H IGH IN P HOSPHORUS Brand NameFlavorsP Content (mg) FantaAll Flavors~10 Gatorade / G2All Flavors36 Coke / PepsiDiet or Regular40 – 65 NesteaAll Bottled47 – 71 Propel WaterAll Flavors~90 Tropicana Fruit DrinksAll Flavors53 – 140 Lipton TeaAll Bottled100 – 200 2% Milk (8 oz)229 Hawaiian PunchAll Flavors260 * Based on 12 oz servings

R EFERENCES Sherman RA, Mehta O: Phosphorus and Potassium Content of Enhanced Meat and Poultry Products: Implications for Patients Who Receive Dialysis. Clin J Am Soc Nephrol 4: , Noori N, Kalantar-Zadeh K, Kovesdy CP, Bross R, Benner D, Kopple JD: Association of Dietary Phosphorus Intake and Phosphorus to Protein Ratio with Mortality in Hemodialysis Patients. Clin J Am Soc Nephrol 5: , Kalantar-Zadeh K, Gutekunst L, Mehrotra R, Kovesdy CP, Bross R, Shinagerger CS, Noori N, Hirschberg R, Brenner D, Nissenson AR, Kopple JD: Understanding Sources of Dietary Phosphorus in the Treatment of Patients with Chronic Kidney Disease. Clin J Am Soc Nephrol , KDOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease. American Journal of Kidney Disease 42: 3, 1-202, 2003.