title: Effect of food additives on hyperphosphatemia among patients with end-stage renal disease: a randomized controlled trial.
abstract: BACKGROUND
  High dietary phosphorus intake has deleterious consequences for renal patients and is possibly harmful for the general public as well. To prevent hyperphosphatemia, patients with end-stage renal disease limit their intake of foods that are naturally high in phosphorus. However, phosphorus-containing additives are increasingly being added to processed and fast foods. The effect of such additives on serum phosphorus levels is unclear.
  
  
  OBJECTIVE
  To determine the effect of limiting the intake of phosphorus-containing food additives on serum phosphorus levels among patients with end-stage renal disease.
  
  
  METHODS
  Cluster randomized controlled trial at 14 long-term hemodialysis facilities in northeast Ohio. Two hundred seventy-nine patients with elevated baseline serum phosphorus levels (>5.5 mg/dL) were recruited between May and October 2007. Two shifts at each of 12 large facilities and 1 shift at each of 2 small facilities were randomly assigned to an intervention or control group.
  
  
  METHODS
  Intervention participants (n=145) received education on avoiding foods with phosphorus additives when purchasing groceries or visiting fast food restaurants. Control participants (n=134) continued to receive usual care.
  
  
  METHODS
  Change in serum phosphorus level after 3 months.
  
  
  RESULTS
  At baseline, there was no significant difference in serum phosphorus levels between the 2 groups. After 3 months, the decline in serum phosphorus levels was 0.6 mg/dL larger among intervention vs control participants (95% confidence interval, -1.0 to -0.1 mg/dL). Intervention participants also had statistically significant increases in reading ingredient lists (P<.001) and nutrition facts labels (P = .04) but no significant increase in food knowledge scores (P = .13).
  
  
  CONCLUSIONS
  Educating end-stage renal disease patients to avoid phosphorus-containing food additives resulted in modest improvements in hyperphosphatemia.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00583570.
authors.affiliation: Division of Nephrology, MetroHealth Medical Center, 2500 MetroHealth Dr, Cleveland, OH 44109, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Sullivan
authors.forename: Srilekha S
authors.initials: SS
authors.lastname: Sayre
authors.forename: Janeen B
authors.initials: JB
authors.lastname: Leon
authors.forename: Rhoderick
authors.initials: R
authors.lastname: Machekano
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Love
authors.forename: David
authors.initials: D
authors.lastname: Porter
authors.forename: Marquisha
authors.initials: M
authors.lastname: Marbury
authors.forename: Ashwini R
authors.initials: AR
authors.lastname: Sehgal
mesh_terms: D000328:Adult; D000368:Aged; D004032:Diet; D005260:Female; D005503:Food Additives / Q000009:adverse effects; D006801:Humans; D054559:Hyperphosphatemia / Q000209:etiology / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010758:Phosphorus / Q000097:blood; D006435:Renal Dialysis
chemical_list: D005503:Food Additives; D010758:Phosphorus