title: Dietary intervention focused on phosphate intake in hemodialysis patients with hyperphosphoremia.
abstract: BACKGROUND
  Elevated serum phosphorus has been identified as a cardiovascular risk factor. This study aimed to assess the effectiveness of dietary intervention to reduce phosphorus intake and to improve the calcium-phosphorus metabolism in hemodialysis patients.
  
  
  METHODS
  Patients were included in a 6-month, 2-group experimental study if their previous 3-month average serum phosphorus was over 5.5 mg/dl. Patients were allocated to intensive dietary intervention or usual dietary recommendations. The clinical end-points were the multivariate-adjusted change in serum phosphorus and the number of patients who achieved serum phosphorus levels of < 5.5 mg/dl and serum phosphorus levels of < 5 mg/dl.
  
  
  RESULTS
  80 dialysis patients completed the study, 41 in the experimental group and 39 in the control group. After 6 months, phosphorus intake (702 ± 168 vs. 872 ± 242 mg/24 h; p = 0.002) was lower in the experimental group than in the control group, with no inter-group differences in protein-caloric intake. Serum phosphorus decreased 1.67 mg/dl in the experimental group and 0.58 mg/dl in the control group (multivariate-adjusted difference 0.93 mg/ dl; 95% CI 0.34 - 1.52; p = 0.003). Serum phosphorus < 5.5 mg/dl and serum phosphorus < 5 mg/dl were attained more frequently in the experimental group (51 vs. 18%, p = 0.002 and 31.7 vs. 15.4%, p = 0.08 respectively).
  
  
  CONCLUSIONS
  Intensive dietary intervention focusing on phosphorus intake may be useful to reduce phosphorus retention and to improve calcium-phosphorus metabolism in hemodialysis patients.
authors.affiliation: Miguel Servet University, Clinic University, San Juan de Dios, Aragón, Spain. luis.lou@hotmail.com
authors.forename: L M
authors.initials: LM
authors.lastname: Lou
authors.forename: A
authors.initials: A
authors.lastname: Caverni
authors.forename: J A
authors.initials: JA
authors.lastname: Gimeno
authors.forename: R
authors.initials: R
authors.lastname: Moreno
authors.forename: J
authors.initials: J
authors.lastname: Pérez
authors.forename: R
authors.initials: R
authors.lastname: Alvarez
authors.forename: B
authors.initials: B
authors.lastname: Campos
authors.forename: M
authors.initials: M
authors.lastname: García
authors.forename: A
authors.initials: A
authors.lastname: Gutiérrez
authors.forename: S
authors.initials: S
authors.lastname: Bielsa
authors.forename: J
authors.initials: J
authors.lastname: Castilla
authors.forename: A
authors.initials: A
authors.lastname: Sanz
authors.forename: F
authors.initials: F
authors.lastname: Martin
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D054559:Hyperphosphatemia / Q000097:blood / Q000178:diet therapy* / Q000209:etiology; D007674:Kidney Diseases / Q000097:blood / Q000628:therapy*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood*; D016226:Phosphorus, Dietary / Q000009:adverse effects*; D006435:Renal Dialysis / Q000009:adverse effects*; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; C470125:PTH protein, human; D010281:Parathyroid Hormone; D016226:Phosphorus, Dietary; D010758:Phosphorus; D002118:Calcium