Kidney Diet Tips

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What is all the Fuss about Phosphorus?

Imagine this. It is time to review your monthly dialysis nutrition lab report with your dietitian. She tells you that your phosphorus level is high. And you are thinking, “What’s the big deal? She has no idea how inconvenient it is to have to take all of these big pills when I eat” or ”It’s really hard to stay on this diet because I like a lot of foods that are high in phosphorus. Why does she keep harping on my phosphorus level?” So is it such a big deal to keep your phosphorus in check? Yes. Let’s talk about why.

One of the jobs of healthy working kidneys is to maintain the balance of minerals in our body, including phosphorus, sodium, potassium, and calcium. But when our kidneys fail and hemodialysis is required, we need to be more vigilant of our habits in order to maintain the proper balance of these minerals.

What is phosphorus anyway? 

Phosphorus is a mineral that we get from the foods we eat. It is naturally occurring but is also added into food as phosphate additives to prevent food from going bad quickly. Phosphorus in the body is an essential mineral, primarily used for growth and repair of body cells and tissues. It is a part of every cell. It is also required for a variety of biochemical processes including energy production and pH regulation. But most of the phosphorus in our bodies is found in bones and teeth, and works with calcium to provide structure and strength where we need it.

What is an acceptable range for phosphorus for a dialysis patient? 

If you are on dialysis, aim for a phosphorus blood result between 3.0 to 5.5 mg/dl. A low phosphorus diet goal is 800 to 1,000 mg phosphorus a day. This amount may be higher for dialysis patients who on a very high protein diet.

What does a low phosphorus level indicate? 

A low phosphorus level may indicate poor appetite, low protein intake, malabsorption or taking too many phosphate binders.

What does a high phosphorus level indicate? 

Your phosphorus level is one of the blood levels that is pretty much governed by your habits. So your phosphorus level is dictated by you and the choices you make each day. The numbers are indicative of whether you are following your diet and taking your phosphorus binders or not. Although some phosphorus is cleaned out of your blood during dialysis, the primary way to keep your phosphorus levels in range is to take your binders and avoid high phosphorus foods.

What’s the big deal if my phosphorus is high? 

If your phosphorus levels are consistently high, it leeches the calcium from your bones, making your bones weaker. Also, it causes calcification of your arteries and soft tissues. Basically this means your bones become soft and your arteries become hard. Complications include pain, broken bones, decreased mobility, heart attack or stroke. To help avoid these complications it is important to keep intake of phosphorus within balance. Plus, adhere to the prescribed binder regimen.

How do I keep my phosphorus in balance? 

Limit high phosphorus foods such as dairy product (cheese, milk and yogurt), chocolate, nuts, beans, corn and corn products. Many canned and bottled beverages contain phosphoric acid. Phosphates are added to food and act as stabilizers or flavor enhancers. So if you are eating  processed or prepackaged foods, chances are you are eating a food that has phosphate additives. Look for the part of the word “phos” within an ingredient list so that you are aware when you are eating a food that is high in phosphorus. And take your binders as prescribed. Your body will thank you. And so will your dietitian.

Food Choices

Most dietitians agree the best approach to controlling phosphorus is to avoid items that contain phosphate additives. When selecting between similar foods that naturally contain phosphorus, choose the one lowest in phosphorus. When choosing a healthy food naturally high in phosphorus, discuss the portion size and frequency with your dietitian.

Check out some choices on this video:

Always consult your doctor or dietitian for more information about the diet requirements for your specific condition.

Rasheeda Mustafa, MS, RD, CD-N

Rasheeda Mustafa, MS, RD, CD-N

Rasheeda Mustafa, MS, RD, CD-N has been a dietitian for 18 years, having worked predominantly with the geriatric population in long term care, short term rehab and home care. She has worked with DaVita almost 2 years, currently practicing in Bronx, NY. What she enjoys best about working in renal is the experience of learning a completely new aspect of nutrition as well as the camaraderie that she shares with her new colleagues and the interactions she has with her patients. Her previous background was in the food service industry, having attended The Culinary Institute of America and working in high end restaurants for such notable chefs as Emeril Lagasse. She enjoys travelling near and far and has been an avid practitioner of yoga for 12 years.