The study evaluated replacing part of the dietary protein intake of 27 hemodialysis patients with hyperphosphataemia with a low-phosphorus whey protein concentrate. Patients were randomly assigned to either continue their usual diet or partially replace morning milk and lunch meats/proteins with the concentrate. At 3 months, patients using the concentrate showed significant decreases in serum phosphate and PTH levels, while control patients did not. Further research is needed to verify the results and ensure long-term protein sufficiency, but low-phosphate protein supplements may help control phosphorus levels in renal failure patients.

1. www.pronutritionist.net
Dietary phosphate restriction in
dialysis patients: A new approach
for the treatment of
hyperphosphataemia
Guida B et al.
Nutr Metab Cardiovasc Dis 2010; Jul 5.
(Epub ahead of print])
Page 1 Guida B et al. Nutr Metab Cardiovasc Dis 2010; Jul 5
(e-pub ahead of print)

2. Page 2
Background
• Elevated serum phosphate and calcium phosphate levels are common problems in
chronic kidney disease bacause elimination of phosphorus is impaired
• Secondary hyperparathyroidism and renal osteodystrophy are common co-
morbidities in chronic kidney diasease
• Dietary phosphate restriction is necessary in renal failure patients with
hyperphosphataemia
• Dietary intake of phosphate mainly comes from protein sources
– dietary protein/phosphorus restriction may lead to a protein/energy malnutrition
in a dialysis patient
• Elevated serum phosphate and calciumphosphate levels play are associated the
pathogenesis of vascular calcifications in renal failure patients and appear to be
associated with increased cardiovascular mortality (Giachelli 2009)
• High dietary phosphate intake is the most significant contributor to high serum
phosphate levels
Guida B et al. Nutr Metab Cardiovasc Dis 2010; Jul 5
(e-pub ahead of print)
www.pronutritionist.net

3. Methods
• n = 27
– all undergoing hemodialysis
– all had hyperphosphataemia
– all were clinically stable and without other illness
• patients were randomly assigned (50/50)to
– maintain their usual diet (control group)
– or partially replace dietary protein intake with a low-phosphorus and
low potassium whey protein concentrate powder (intervention group)
including just 0,21 grams phosphorus per 100 g
– In active group, participants replaced morning milk and lunch
meat/fish/poultry/eggs by low-phosphorus powder
• all patients continued to consume their usual phosphate binders
• study duration was 3 months
Page 3 Guida B et al. Nutr Metab Cardiovasc Dis 2010; Jul 5
(e-pub ahead of print)
www.pronutritionist.net

4. Results, laboratory values
• At the end of follow-up
– patients of the intervention group showed a significant
decrease in mean serum phosphate and iPTH levels
– no significant changes were found in the control group
– no significant changes in serum albumin, calcium, potassium
and body weight were observed in both groups
Page 4 Guida B et al. Nutr Metab Cardiovasc Dis 2010; Jul 5
(e-pub ahead of print)
www.pronutritionist.net

5. Results nutrient intake
www.pronutritionist.netGuida B et al. Nutr Metab Cardiovasc Dis 2010;
Jul 5 (e-pub ahead of print)
5
-37 %
- 23
%
Low-phosporus protein powder substitution vs baseline (at 3 months)
Phosphate intake Potassium intake Protein intake
unchanged*
In the control group, no significant differences in phosphate, potassium, energy and
protein intake were observed at the end of the study
*) authors state: “ no significant differences were observed for energy and protein intake”.
However table 4 demonstrates 0,5 g/kg decrease in protein intake vs baseline (non-significant)
?

6. Discussion
• The present study shows that a partial replacement of
natural foods (high in phosphate), with a low-phosphorus
protein concentrate, does affect serum phosphate levels in
dialysis patients with hyperphosphataemia
• Because of the size of the study, short duration and design
of the control group, more studies are needed to verify the
outcomes
• Especially long term sufficiency of protein intake needs
further confirmation
• Despite the limitations of the studies, partial substitution of
natural protein sources by low phosphate protein
supplements may become one viable means to further
control phosphorus load in renal failure
Page 6 Guida B et al. Nutr Metab Cardiovasc Dis 2010; Jul 5
(e-pub ahead of print)
www.pronutritionist.net

7. Discussion
• The present study shows that a partial replacement of
natural foods (high in phosphate), with a low-phosphorus
protein concentrate, does affect serum phosphate levels in
dialysis patients with hyperphosphataemia
• Because of the size of the study, short duration and design
of the control group, more studies are needed to verify the
outcomes
• Especially long term sufficiency of protein intake needs
further confirmation
• Despite the limitations of the studies, partial substitution of
natural protein sources by low phosphate protein
supplements may become one viable means to further
control phosphorus load in renal failure
Page 6 Guida B et al. Nutr Metab Cardiovasc Dis 2010; Jul 5
(e-pub ahead of print)
www.pronutritionist.net