Nephrology Dialysis Transplantation, Vol 13, Issue 90003 65-67, Copyright © 1998 by Oxford University Press
M Rufino, E de Bonis, M Martin, S Rebollo, B Martin, R Miquel, M Cobo, D Hernandez, A Torres and V Sellares
Dietary intervention, phosphate (P) removal during dialysis and,
especially, phosphate binders are current methods for the management of
hyperphosphataemia. Ideally, the amount of P absorbed from the diet should
equal the amount of P removed during dialysis, and this must occur in the
context of an adequate protein intake. We evaluated the relationship
between P intake and protein intake in 60 stable chronic uraemic patients
(mean age 55±15 years, 25% diabetics, 68% males) on standard 4 h
haemodialysis. The dietary counselling was relatively free for protein and
calories. Nutrient intake was recorded during a 5 day period, and average
daily ingestion of P and proteins was calculated using a computerized diet
analysis system. A highly significant correlation was observed between
protein and P intake. The mean daily ingestion of P and proteins was
998±316 mg and 64±19 g (1±0.4 g/kg/day),
respectively. For an optimal protein diet of 1-1.2 g/kg/day, the P intake
was 778-1444 mg. The amount of P removed by haemodialysis, extrapolated to
an average week, is 250-300 mg/day. Since 40% of P ingested is absorbed
from the gut by uraemic patients treated with intestinal P binders, 750 mg
of P intake should be the critical value above which a positive balance of
P may occur. This value corresponds to a protein intake of 45-50 g per day
(>0.8 g/kg body weight/day for a 60 kg patient). In patients
undergoing standard chronic haemodialysis, a neutral P balance is difficult
to achieve, despite phosphate binder therapy, when protein intake is
>50 g. Additional protein restriction, in order to obtain a neutral
balance, may impose the risk of protein malnutrition.Keywords:
chronic haemodialysis; dietary phosphorus; hyperphosphataemia;
malnutrition; protein intake
ORIGINAL ARTICLES
Is it possible to control hyperphosphataemia with diet, without inducing protein malnutrition?
Nephrology Service, Hospital Universitario Canarias and Nephrology Section, Hospital Tamaragua, Santa Cruz de Tenerife, Spain; Corresponding author address: Servicio de Nefrologia, Hospital Universitario de Canarias, Ofra, La Laguna, CP 38230, Santa Cruz de Tenerife, Spain
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