Phosphorus Restriction

Hyperphosphatemia would not be a problem without dietary phosphorus ingestion and vascular calcification would most likely be less of a problem. However, although dietary phosphorus restriction is always listed as a corner stone of phosphate management, it is rarely performed successfully in clinical practice for various reasons.

(1) Patients need excessive dietary advice and teaching to be able to restrict phosphorus intake while maintaining an adequate protein/calorie intake. In healthy individuals the average dietary phosphorus intake ranges from 1,000 in females to 1,800 mg/day in males.

(2) Since dietary phosphorus ingestion is closely related to protein intake, phosphorus restriction bears the risk of developing protein malnutrition. For dialysis patients a protein intake of 1.0-1.2 g/kgbody weight/day and maximum phosphorus intake of 1,000 mg/day has been recommended, but a much lower mean dietary intake has been reported with 53.7 8 28.6 g for protein and 903 8 468 mg/day for phosphorus [21]. Achieving adequate dietary protein intake will, in most cases, be associated with higher phosphorus intake.

(3) Available tables and booklets listing phosphorus and protein content of food components are cumbersome and time-consuming to use. Even beverages available in the US vary substantially in their iP content [22].

(4) Phosphorus-containing additives in unknown amounts are frequently used for food preservation. It has been estimated that phosphorous intake from additives may amount to 1,000 mg/day [23]. Phosphorus additives are absorbed almost 100% into the circulation. Manufacturers are not required to list the phosphorous content on food labels, thus making it difficult for patients to identify those high-phosphorus foods.

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