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Archive for Phosphorus

July 30, 2015

Thirst Quenching Flavored Water for Hot Summer Days

By guest blogger DaVita Dietitian Kara Hansen, MS, RDNiStock_000047085042_Small Rasp Water

Summer is here and so is the heat! Nothing quenches thirst like an ice cold beverage. If you are a kidney patient who’s watching fluid intake, always be aware of how much fluid you are drinking, especially in the summer when tempted to drink more because of the heat. It’s a good idea to check with your dietitian to find out how many ounces or cups are allowed each day for fluid. Read more…

April 28, 2015

New Phosphorus Pyramid: Today’s Focus on Phosphorus for Kidney Patients

The Phosphorus Pyramid, a new tool for learning about phosphorus control, was created by researchers Claudia D’Alessandro, Giorgina B Piccoli, and Adamasco Cupisti from Italy. This pyramid does not focus on phosphorus content of foods alone. It incorporates the newer focus on phosphorus load–how much phosphorus is retained due to digestion, absorption and removal (by the kidneys, dialysis and/or phosphate binders). Read more…

February 10, 2014

Kidney Diet Double Ps -Potassium and Phosphorus

SONY DSCPeople on dialysis have heard more than once to watch their phosphorus and potassium consumption on the kidney diet. When it comes to Potassium, Phosphorus and the Dialysis Diet, this may be the biggest challenge for many dialysis patients. First, remembering the difference between the two Ps. Read more…

November 19, 2013

Why are phosphorus binders important?

iStock_000011386435XSmall-pillsPhosphorus is a mineral necessary to maintain good health; however, people with chronic kidney disease who are on dialysis are not able to eliminate excess phosphorus efficiently. High phosphorus levels can lead to heart disease, brittle bones, itchy skin and other complications so a low phosphorus diet as well as phosphorus binders are prescribed to help block some of the phosphorus consumed in foods. Read more…

May 30, 2013

Kidney Diet Tip: Phosphate-free Kool-Aid®

I grew up before the plethora of canned and bottled beverage choices. In our household thirsty kids had 3 beverage choices: water, home brewed iced tea or Kool-Aid®. Coca cola®, aka Coke® was an occasional treat. I preferred the orange or punch-flavored Kool-Aid over water or sweet tea.

Fast forward to 2013: water is enhanced with vitamins and minerals, including phosphorus; tea is available pre-made in cans and bottles, some brands with phosphate additives; Kool-Aid powder no longer gets clumpy, thanks to the calcium-phosphate additive. All are red flags for kidney patients who are following a kidney diet and avoiding phosphate additives.

Today I was pleasantly surprised to discover the new Kool-Aid® Liquid Drink Mix does not contain calcium-phosphate additives, plus it’s sugar-free. Each 1.67 ounce container has 24 servings of a liquid Kool-Aid concentrate you squirt into a bottle or glass of chilled water. Approximately 1/2 teaspoon makes an 8-ounce serving of Kool-Aid with zero calories, carbohydrate and phosphorus. Sodium is low at 0 to 10 mg a cup (all flavors are sodium-free except orange). Potassium is not provided but it is in the product since it contains acesulfame potassium (sweetener) and potassium sorbate (preservative).

Read more…

February 27, 2013

Kidney Diet Tips on Phosphate Additives – Your Great Phosphorus Saver (G.P.S.) Guide

DaVita Dietitian Julia from Ohio is today’s guest blogger with some great kidney diet tips about phosphorus.

Phosphorus by the Numbers

  • 250 mg to 1,000 mg of phosphorus is the amount removed in a dialysis treatment
  • 800 mg to 1000 mg of phosphorus per day is the typical daily target for a low phosphorus kidneydiet
  • 85% of fast food entrees and side dishes contain phosphate additives
  • 28% to 100% – a recent review of frozen chicken products revealed that the frozen chicken contained 28% to 100% more phosphorus than unenhanced fresh or frozen chicken.
  • 40% to 60% of the phosphorus that NATURALLY occurs in foods is absorbed into the bloodstream.
  • 90% to 100% of the phosphorus that is ADDED to foods, as a food additive, is absorbed into the bloodstream.
  • 100% of dialysis patients will benefit from avoiding foods with phosphate additives!

Just knowing that because your kidneys cannot remove phosphorus you need to avoid phosphate additives is the first step.  Knowing where these additives are found and how to avoid them is the all important next step.  Think of this article as your G.P.S. for phosphorus additives (G.P.S. – “great phosphorus saver”). Read more…

August 1, 2012

Normal Phosphorus in Early Kidney Disease: The FGF-23 Link

Phosphorus is a big deal for chronic kidney disease (CKD) patients, but often isn’t addressed until dialysis is needed. Thanks to a very efficient regulating hormone called fibroblastic growth factor-23 (FGF-23), blood phosphorus levels stay normal, usually until stages 4 & 5 CKD. What’s not obvious is that phosphorus can cause damage despite normal lab values, even in early kidney disease.

It’s well documented that excess phosphorus intake is bad, and we’re consuming more now than ever before. Here’s what we know:

  • In the general population, risk for developing cardiovascular disease increases as phosphorus levels increase—even within the normal range.
  • Lower phosphorus intake may help preserve kidney function in earlier stage CKD patients.
  • In patients with early CKD a lower phosphorus diet is linked to better parathyroid hormone (PTH) control. Excessive levels of this hormone contributes to bone disease and calcification.
  • Studies of phosphorus and  dialysis patients show that high phosphorus levels above 5.5 mg/dL  are linked to greater risk of hospitalization and death.
  • The use of phosphate additives in foods has sky-rocketed over the past 10 years, contributing an additional 1000 mg of extra phosphate a day, and this type of phosphate is absorbed 90-100% compared to 40-60% absorption form phosphates naturally occurring in food.
  • Almost all fast foods and 50% of the most popular grocery items have phosphate additives (start reading the ingredients on everything you buy).

The reason phosphorus stays normal until later stages of CKD is the hormone FGF-23 takes action to increase phosphorus excretion in the urine. This usually starts when glomerular filtration rate (GFR) is around 60-80. As FGF-23 increases so does risk of death for people with CKD.

FGF-23 can be reduced by low phosphorus intake and avoidance of phosphate additives.  Vegetarian diets or, for meat eaters, eating less meat and replacing meat with plant proteins also helps lower FGF-23.

Checking PTH and FGF-23 levels may become more important than looking at phosphorus levels in the future for patients with early CKD. But more evidence is building up to support following a lower phosphorus diet even when phosphorus is normal on the lab report.

Stay tuned as we learn more about FGF-23 and phosphorus control in early kidney disease.

Kidney diet resources from DaVita.com


December 21, 2011

Selecting the best cheese for a kidney diet

Cheese is a featured ingredient in this month’s DaVita recipe collection, Kidney-Friendly Cheesy Appetizers. Almost everyone likes cheese, but kidney patients are told to limit or even avoid it due to the phosphorus content. In addition, some cheeses are quite high in sodium. Read more…

September 6, 2011

Dietary phosphorus control to prevent or delay kidney failure

You may have chronic kidney disease (CKD) and not even know it. An estimated 17% of US adults have chronic kidney disease and many are undiagnosed. There are 5 stages of kidney disease: stage 1 CKD represents kidney damage with normal kidney function; stage 2 kidney disease is mild kidney disease; stage 3 chronic kidney disease is moderate kidney failure; stage 4 CKD is severe and stage 5 is end stage renal disease which requires dialysis or kidney transplant. If you have kidney disease and you’re looking for ways to preserve kidney function through diet, pay attention to this latest study published in the August 2011 online Journal of the American Society of Nephrology. Read more…

December 16, 2010

Dietary Phosphate Prescription and Survival in Dialysis Patients

“CUTTING DIETARY PHOSPHATE DOESN’T SAVE DIALYSIS PATIENTS’ LIVES” is the latest headline in nephrology news. So does that mean the struggles to control your phosphorus are no longer important?

The study titled “The Association between Prescribed Dietary Phosphate Restriction and Mortality among Hemodialysis Patients” by Lynch, et al is in the online December 2010 issue of the Clinical Journal of the American Society of Nephrology. According to the findings, ‘Dietary phosphate prescription was not associated with improved survival in hemodialysis patients and in some subgroups there may be greater mortality.’ In other words, having a lower phosphorus diet prescription does not necessarily mean hemodialysis patients live longer. The range of blood phosphorus values was similar for all the diet groups (3.8-7.9 mg/dL). Of note, analysis of subgroups with greater survival reveals that participants with phosphorus below 5.5 mg/dL still had a survival advantage.

Finding of the study include: Read more…

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