Author/Authors :
Noori, Nazanin Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center - Harold Simmons Center for Chronic Disease Research and Epidemiology, USA , Noori, Nazanin David Geffen School of Medicine at UCLA, USA , Sims, John J Kaiser Permanente Sunset, USA , Kopple, Joel D Los Angeles Biomedical Research Instituteat Harbor-UCLA Medical Center - Harold Simmons Center for Chronic Disease Research and Epidemiology, USA , Kopple, Joel D UCLA School of Public Health - Departments of Epidemiology or Community Health Sciences, USA , Kopple, Joel D David Geffen School of Medicine at UCLA, USA , Shah, Anuja David Geffen School of Medicine at UCLA, USA , Shah, Anuja Los Angeles Biomedical Research Instituteat Harbor-UCLA Medical Center - Harold Simmons Center for Chronic Disease Research and Epidemiology, USA , Colman, Sara DaVita, USA , Shinaberger, Christian S Los Angeles Biomedical Research Instituteat Harbor-UCLA Medical Center - Harold Simmons Center for Chronic Disease Research and Epidemiology, USA , Shinaberger, Christian S UCLA School of Public Health - Departments of Epidemiology or Community Health Sciences, USA , Bross, Rachelle Los Angeles Biomedical Research Instituteat Harbor-UCLA Medical Center - Harold Simmons Center for Chronic Disease Research and Epidemiology, USA , Bross, Rachelle David Geffen School of Medicine at UCLA, USA , Mehrotra, Rajnish Los Angeles Biomedical Research Instituteat Harbor-UCLA Medical Center - Harold Simmons Center for Chronic Disease Research and Epidemiology, USA , Mehrotra, Rajnish David Geffen School of Medicine at UCLA, USA , Kovesdy, Csaba P Salem Veterans Affairs Medical Center - Division of Nephrology, USA , Kovesdy, Csaba P University of Virginia - Department of Medicine, USA , Kalantar-Zadeh, Kamyar Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center - Harold Simmons Center for Chronic Disease Research and Epidemiology, USA , Kalantar-Zadeh, Kamyar David Geffen School of Medicine at UCLA, USA , Kalantar-Zadeh, Kamyar UCLA School of Public Health - Departments of Epidemiologyor Community Health Sciences, USA
Abstract :
Dietary phosphorus control is often a main strategy in the management of patients with chronic kidney disease. Dietary protein is a major source of phosphorus intake. Recent data indicate that imposed dietary phosphorus restriction may compromise the need for adequate protein intake, leading to protein-energy wasting and possibly to increased mortality. The two main sources of dietary phosphorus are organic, including animal and vegetarian proteins, and inorganic, mostly food preservatives. Animal-based foods and plant are abundant in organic phosphorus. Usually 40% to 60%of animal-based phosphorus is absorbed; this varies by degree of gastrointestinal vitamin-D-receptor activation, whereas plant phosphorus, mostly associated with phytates, is less absorbable byhuman gastrointestinal tract. Up to 100% of inorganic phosphorus in processed foods may be absorbed; ie, phosphorus in processed cheese and some soda (cola) drinks. A recent study suggests that a higher dietary phosphorus-protein intake ratio is associated with incremental death risk in patients on long-term hemodialysis. Hence, for phosphorus management in chronic kidney disease,in addition to absolute dietary phosphorus content, the chemical structure (inorganic versus organic), type (animal versus plant), and phosphorus-protein ratio should be considered. We recommendfoods and supplements with no or lowest quantity of inorganic phosphorus additives, more plant-based proteins, and a dietary phosphorus-protein ratio of less than 10 mg/g. Fresh (nonprocessed) egg white (phosphorus-protein ratio less than 2 mg/g) is a good example of desirable food, which contains a high proportion of essential amino acids with low amounts of fat, cholesterol, and phosphorus.
