Dietary phosphate restriction in dialysis patients: a new approach for the treatment of hyperphosphataemia.
OBJECTIVE
Elevated serum phosphate and calcium-phosphate levels play an important role in the pathogenesis of vascular calcifications in uraemic patients and appear to be associated with increased cardiovascular mortality. We aimed to evaluate the effects of a partial replacement of food protein with a low-phosphorus and low-potassium whey protein concentrate on phosphate levels of dialysis patients with hyperphosphataemia.


RESULTS
Twenty-seven patients undergoing chronic haemodialysis were studied for a 3-month period. In the intervention group (n = 15), food protein were replaced by 30 or 40 g of low-phosphorus and low-potassium protein concentrate aimed at limiting the phosphate intake. In the control group (n = 12) no changes were made to their usual diet. Anthropometric measurements, biochemical markers and dietary interviews were registered at baseline and during the follow-up period. From baseline to the end of the study, in the intervention group, serum phosphate and circulating intact parathyroid hormone levels lessened significantly (8.3 ± 1.2 mg/dL vs 5.7 ± 1.4 mg/dL and 488 ± 205 pg/ml vs 177 ± 100 pg/ml respectively; p < 0.05) with decreasing of phosphate and potassium intake. No significant differences were found in the control group. No significant changes were observed in serum albumin, calcium, potassium, Kt/V, body weight and body composition in both the intervention and control groups.


CONCLUSIONS
Dietary intake of phosphate mainly comes from protein sources, so dietary phosphorus restriction may lead to a protein/energy malnutrition in a dialysis patient. A phosphorus-controlled diet plan including a nutritional substitute resulted in serum phosphate and intact parathyroid hormone decrease without nutritional status modifications in dialysis patients.
Guida
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Department of Neuroscience, Physiology Nutrition Unit, University Federico II, Naples, Italy. bguida@unina.it
Piccoli
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Trio
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Laccetti
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Nastasi
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Paglione
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Memoli
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Memoli
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D004032:Diet; D004044:Dietary Proteins / Q000008:administration & dosage* / Q000032:analysis; D005260:Female; D006801:Humans; D054559:Hyperphosphatemia / Q000178:diet therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008894:Milk Proteins / Q000008:administration & dosage*; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D016226:Phosphorus, Dietary / Q000008:administration & dosage*; D017419:Potassium, Dietary / Q000008:administration & dosage; D006435:Renal Dialysis; D014511:Uremia / Q000628:therapy; D000067816:Whey Proteins
D004044:Dietary Proteins; D008894:Milk Proteins; D010281:Parathyroid Hormone; D010710:Phosphates; D016226:Phosphorus, Dietary; D017419:Potassium, Dietary; D000067816:Whey Proteins