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Understanding Hyperphosphatemia in Dialysis Patients

Hyperphosphatemia occurs when there is an excess of phosphorus in the blood. For dialysis patients, the kidneys cannot effectively filter out excess phosphorus, resulting in a dangerous buildup. Over time, high phosphorus levels can cause severe complications, such as:

• Weak and brittle bones (osteoporosis)
• Calcium deposits in blood vessels, heart, and tissues, increasing the risk of cardiovascular disease
• Itchy skin and joint pain

Managing phosphorus levels through diet and dialysis treatment is crucial for maintaining bone health and preventing cardiovascular issues.

Despite being on dialysis, high phosphorus levels may occur due to:

• Dietary choices: Eating foods rich in phosphorus, especially processed or convenience foods that contain hidden phosphate additives.
• Skipping or incorrect use of phosphorus binders: Medications prescribed to control phosphorus absorption.
• Non-food sources of phosphorus: Beverages like dark sodas and foods containing preservatives with phosphate additives can significantly contribute to high phosphorus levels.
• Higher Bioavailability of Phosphate Additives: Phosphates added to processed foods and beverages are absorbed more easily by the body compared to natural phosphorus found in whole foods.
• Inadequate dialysis: In some cases, dialysis alone is not enough to remove all the excess phosphorus.

Controlling your diet is a key part of managing phosphorus levels.

Protein -Phosphorus Ratio

Since dialysis patients need adequate protein intake to maintain muscle and overall health, it is important to choose protein sources with a favorable protein-to-phosphorus ratio. This means selecting foods that provide high-quality protein with lower phosphorus content.

• Better protein choices (low phosphorus, high protein):
• Egg whites
• Fresh fish (e.g., cod, tilapia)
• Chicken or turkey (skinless)
• Beef or pork (lean cuts)
• Proteins to limit (high phosphorus):
• Organ meats (liver, kidney)
• Processed meats (sausages, bacon)
• Shellfish (shrimp, crab, lobster)
• Dairy-based proteins (cheese, milk, yogurt)

When consuming protein, it is essential to take phosphorus binders as prescribed to minimize phosphorus absorption from your meals. Phosphorus binders must be taken with the first bite of food to ensure they work effectively by binding to the phosphorus in the meal. Skipping doses or taking them after eating significantly reduces their effectiveness.

Asian Foods High in Phosphorus to Avoid

• Soy-based products: Tofu, soy milk, and tempeh often contain significant phosphorus levels. Check for fortified or processed varieties, which may have added phosphates.
• Fish roe and dried fish: Common in many Asian dishes, these are particularly high in phosphorus.
• Fish with edible bones: Fish like sardines, anchovies, or certain small dried fish often consumed with their bones are especially high in phosphorus. The bones are a concentrated source of phosphorus, and consuming them increases total phosphorus intake significantly.
• Fermented foods: Miso, fermented bean curd, and similar products often have added phosphorus as preservatives or flavor enhancers.
• Rice bran and brown rice: While a staple in many diets, they have higher phosphorus levels compared to polished white rice.
• Instant noodles: These often contain phosphate additives in their flavor packets.
• Asian sauces: Soy sauce, oyster sauce, hoisin sauce, and fish sauce frequently contain added phosphates. Use these sparingly or opt for low-phosphorus alternatives.

High-Phosphorus Foods to Avoid

• Dairy products: Cheese, milk, yogurt, ice cream.
• Processed foods: Sausages, canned goods, processed meats, and fast food often contain phosphate additives.
• Nuts and seeds: Almonds, cashews, sunflower seeds.
• Whole grains and bran cereals: These have high phosphorus levels compared to refined options.
• Dark colas and beer: These beverages are high in phosphorus due to added phosphoric acid.

Non-Food Phosphorus Sources to Be Aware Of

• Sodas and soft drinks: Dark colas and certain flavored drinks often contain phosphoric acid as a preservative. These additives are highly bioavailable, meaning they are absorbed into the bloodstream much more efficiently than natural phosphorus found in whole foods.
• Preservatives in processed foods: Ingredients like "phosphates" or "phosphoric acid" are common in processed snacks, frozen meals, and fast foods. These contribute significantly to overall phosphorus intake because of their high bioavailability.
• Baking powders and leavening agents: Found in baked goods, these can also contain phosphate additives that are quickly absorbed by the body.

Low-Phosphorus Food Options

• Fruits and vegetables: Apples, berries, cucumbers, and cabbage are good choices.
• Protein alternatives: Egg whites, fresh fish, or poultry without skin (limit portion size).
• Starches: White bread, pasta, rice, and cornflakes.

Look out for ingredients like "phosphate" or "phosphoric acid" on packaged foods and beverages. Phosphate additives can dramatically increase your phosphorus intake due to their high bioavailability, making it even more crucial to avoid such products.

Phosphorus Binders
These medications reduce the amount of phosphorus absorbed from food. To work effectively:

• Take them with meals and snacks as prescribed. Phosphorus binders must be taken with the first bite of food for optimal effectiveness.
• Avoid skipping doses, especially during large meals.
• Let your healthcare team know if you have side effects like constipation or nausea, so adjustments can be made.

Common Types of Phosphorus Binders:

• Calcium-based binders (e.g., calcium acetate).
• Non-calcium binders (e.g., sevelamer, lanthanum carbonate).

Additional Tips for Better Control

1. Attend All Dialysis Sessions: Skipping or shortening sessions can result in inadequate phosphorus removal.
2. Monitor Labs Regularly: Keep track of your phosphorus levels and discuss trends with your healthcare provider.
3. Work with a Dietitian: They can customize meal plans to fit your preferences while keeping phosphorus low.

If untreated, hyperphosphatemia can lead to serious health issues, including:

• Increased risk of heart disease.
• Worsening bone health and fractures.
• Persistent itching or skin lesions.

Taking an active role in managing your diet and medications can prevent complications and improve your quality of life.