Understanding Sources of Dietary Phosphorus in the Treatment of Patients with Chronic Kidney Disease

医学 肾脏疾病 生物利用度 透析 适口性 内科学 肾性骨营养不良 营养物 食品科学 生理学 内分泌学 生物 药理学 病理 化学 生态学 有机化学
作者
Kamyar Kalantar‐Zadeh,Lisa Gutekunst,Rajnish Mehrotra,Csaba P. Kövesdy,Rachelle Bross,Christian S. Shinaberger,Nazanin Noori,Raimund Hirschberg,Debbie Benner,Allen R. Nissenson,Joel D. Kopple
出处
期刊:Clinical Journal of The American Society of Nephrology [American Society of Nephrology]
卷期号:5 (3): 519-530 被引量:463
标识
DOI:10.2215/cjn.06080809
摘要

In individuals with chronic kidney disease, high dietary phosphorus (P) burden may worsen hyperparathyroidism and renal osteodystrophy, promote vascular calcification and cardiovascular events, and increase mortality. In addition to the absolute amount of dietary P, its type (organic versus inorganic), source (animal versus plant derived), and ratio to dietary protein may be important. Organic P in such plant foods as seeds and legumes is less bioavailable because of limited gastrointestinal absorption of phytate-based P. Inorganic P is more readily absorbed by intestine, and its presence in processed, preserved, or enhanced foods or soft drinks that contain additives may be underreported and not distinguished from the less readily absorbed organic P in nutrient databases. Hence, P burden from food additives is disproportionately high relative to its dietary content as compared with natural sources that are derived from organic (animal and vegetable) food proteins. Observational and metabolic studies indicate nutritional and longevity benefits of higher protein intake in dialysis patients. This presents challenges to providing appropriate nutrition because protein and P intakes are closely correlated. During dietary counseling of patients with chronic kidney disease, the absolute dietary P content as well as the P-to-protein ratio in foods should be addressed. Foods with the least amount of inorganic P, low P-to-protein ratios, and adequate protein content that are consistent with acceptable palatability and enjoyment to the individual patient should be recommended along with appropriate prescription of P binders. Provision of in-center and monitored meals during hemodialysis treatment sessions in the dialysis clinic may facilitate the achievement of these goals.

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