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Currently Available Handouts for Low Phosphorus Diets in Chronic Kidney Disease Continue to Restrict Plant Proteins and Minimally Processed Dairy Products

Published:April 22, 2022DOI:https://doi.org/10.1053/j.jrn.2022.04.002

      Objectives

      The 2020 Kidney Disease Outcome Quality Initiative guidelines recommend adjusting phosphorus intake to achieve and maintain normal serum phosphorus levels for adults living with chronic kidney disease. These guidelines also recommend considering the dietary source of phosphorus as different sources have different bioavailability; however, phosphorus food lists are not provided. Therefore, the aim of this study is to investigate the current teaching materials in Canada regarding low phosphorus diet.

      Design and Methods

      Using a geographical approach, websites from each province and territories' government, health, and renal programs (where applicable) were reviewed for resources on dietary phosphorus restriction in chronic kidney disease. All publicly available handouts/booklets/printable webpages were obtained and reviewed for recommendations on how to implement a low phosphorus diet.

      Results

      Sixty-one resources in total met inclusion criteria (52 handouts from health agencies in 6 provinces and 9 handouts from the Kidney Foundation of Canada). Items with minimal nutrition value, such as cola, beer and cocoa, chocolate, and baking powder, were the most commonly restricted with 84% (51/61) resources making this recommendation. Plant proteins and minimally processed dairy were restricted in 80% (49/61) of resources. Processed animal meat was recommended to be restricted in 70% (43/61) of resources and whole grains in 65% (40/61). Sixty-three percent of the handouts (39/61) discuss avoiding phosphorus additives.

      Conclusions

      Many resources restrict items with minimal nutrition value to lower phosphorus intake; however, plant foods, including plant proteins and whole grains, continue to be restricted in the majority of resources, despite having lower bioavailability. The 2020 Kidney Disease Outcome Quality Initiative guidelines recommend considering bioavailability of phosphorus source when implementing low phosphorus diets; current handouts in Canada would likely benefit from review.

      Keywords

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      References

        • Ikizler T.A.
        • Burrowes J.D.
        • Byham-Gray L.D.
        • et al.
        KDOQI clinical practice guideline for nutrition in CKD: 2020 update.
        Am J Kidney Dis. 2020; 76: S1-S107
        • Moorthi R.N.
        • Armstrong C.L.H.
        • Janda K.
        • Ponsler-Sipes K.
        • Asplin J.R.
        • Moe S.M.
        The effect of a diet containing 70% protein from plants on mineral metabolism and musculoskeletal health in chronic kidney disease.
        Am J Nephrol. 2014; 40: 582-591
        • D'Alessandro C.
        • Piccoli G.B.
        • Cupisti A.
        The “phosphorus pyramid”: a visual tool for dietary phosphate management in dialysis and CKD patients.
        BMC Nephrol. 2015; 16: 9
        • Kopple J.
        • Wolfson M.
        • Chertow G.M.
        • Salusky I.B.
        KDOQI Clinical practice guidelines for nutrition in chronic renal failure.
        Am J Kidney Dis. 2000; 35: 1
        • Johnson D.W.
        • Atai E.
        • Chan M.
        • et al.
        KHA-CARI Guideline: early chronic kidney disease: detection, prevention and management.
        Nephrology (Carlton). 2013; 18: 340-350
        • Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group
        KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease Mineral and Bone Disorder (CKD-MBD).
        Kidney Int Suppl. 2017; 7: 1-59
        • Sullivan C.
        • Sayre S.S.
        • Leon J.B.
        • et al.
        Effect of food additives on hyperphosphatemia among patients with end-stage renal disease: a randomized controlled trial.
        JAMA. 2009; 301: 629-635
        • Picard K.
        • Mager D.R.
        • Richard C.
        The impact of protein type on phosphorus intake, serum phosphate concentrations, and nutrition status in adults with chronic kidney disease: a critical review.
        Adv Nutr. 2021; 12: 2099-2111
        • Picard K.
        • Senior P.A.
        • Perez S.A.
        • Jindal K.
        • Richard C.
        • Mager D.R.
        Low mediterranean diet scores are associated with reduced kidney function and health related quality of life but not other markers of cardiovascular risk in adults with diabetes and chronic kidney disease.
        Nutr Metab Cardiovasc Dis. 2021; 31: 1445-1453
        • Monteiro C.A.
        • Cannon G.
        • Moubarac J.-C.
        • Levy R.B.
        • Louzada M.L.C.
        • Jaime P.C.
        The UN decade of nutrition, the NOVA food classification and the trouble with ultra-processing.
        Public Health Nutr. 2018; 21: 5-17
        • Monteiro C.A.
        • Cannon G.
        • Lawrence M.
        • de Costa Louzada M.L.
        • Pereira Machado P.
        Ultra-Processed Foods, Diet Quality, and Health Using the NOVA Classification System.
        FAO, Rome2019
        • León J.B.
        • Sullivan C.M.
        • Sehgal A.R.
        The prevalence of phosphorus-containing food additives in top-selling foods in grocery stores.
        J Ren Nutr. 2013; 23: 265-270.e2
        • Government of Canada
        Canadian nutrient file.
        • McClure S.T.
        • Chang A.R.
        • Selvin E.
        • Rebholz C.M.
        • Appel L.J.
        Dietary sources of phosphorus among adults in the United States: results from NHANES 2001–2014.
        Nutrients. 2017; 9: 95
        • Fulgoni K.
        • Fulgoni 3rd, V.L.
        Trends in total, added, and natural phosphorus intake in adult Americans, NHANES 1988–1994 to NHANES 2015–2016.
        Nutrients. 2021; 13: 2249
        • Byrne F.N.
        • Gillman B.A.
        • Kiely M.
        • et al.
        Pilot randomized controlled trial of a standard versus a modified low-phosphorus diet in hemodialysis patients.
        Kidney Int Rep. 2020; 5: 1945-1955
        • Afshin A.
        • Sur P.J.
        • Fay K.A.
        • et al.
        Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017.
        Lancet. 2019; 393: 1958-1972
        • Su G.
        • Saglimbene V.
        • Wong G.
        • et al.
        Healthy lifestyle and mortality among adults receiving hemodialysis: the DIET-HD study.
        Am J Kidney Dis. 2022; 79: 688-698.e1
        • St-Jules D.E.
        • Goldfarb D.S.
        • Sevick M.A.
        Nutrient non-equivalence: does restricting high-potassium plant foods help to prevent hyperkalemia in hemodialysis patients?.
        J Ren Nutr. 2016; 26: 282-287
        • St-Jules D.E.
        • Fouque D.
        Is it time to abandon the nutrient-based renal diet model?.
        Nephrol Dial Transplant. 2021; 36: 574-577
        • Sullivan C.M.
        • Leon J.B.
        • Sehgal A.R.
        Phosphorus-containing food additives and the accuracy of nutrient databases: implications for renal patients.
        J Ren Nutr. 2007; 17: 350-354