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The role of dietary phosphate restriction in chronic kidney disease


BACKGROUND AND OBJECTIVES: Patients with progressive chronic kidney disease (CKD) develop positive phosphate balance that is associated with increased cardiovascular risk and mortality. Modification of dietary phosphate is a commonly used strategy to improve outcomes but is complicated by the need for adequate dietary protein. Surprisingly, the evidence for patient-level benefits from phosphate restriction is tenuous, and the justification for using any phosphate binder for pre-dialysis patients is questionable. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: We review the evidence for dietary phosphate modification and the possible role of a smart phone application (app.) that provides information on phosphate, sodium, potassium and nutrients in over 50,000 Australian foods. We performed a pilot study of healthy participants assigned to dietetic advice and standard diet sheets, or dietetic advice, diet sheets and use of the smart phone app. RESULTS: Following baseline studies, 25 participants commenced the sodium and phosphate restricted diet. After two weeks, both groups showed non-significant trends to reduction in urinary phosphate and sodium. App. users referred to information on the app. more frequently than the control group participants referred to written instructions, found referring to the app. more convenient, felt they learned more new information, were more motivated to maintain the diet and were more likely to recommend their information source to family or friends (all p<0.05), CONCLUSIONS: Maintaining phosphate balance remains an important goal of CKD management, although diets incorporating very low phosphate and protein contents may worsen patient outcomes. For selected patients, a smart phone app. may improve dietary acceptance and compliance.

Type Journal
ISBN 1440-1797 (Electronic) 1320-5358 (Linking)
Authors Elder, G. J.; Malik, A.; Lambert, K.
Responsible Garvan Author Prof Grahame Elder
Publisher Name NEPHROLOGY
Published Date 2018-12-16
Published Volume 23
Published Issue 12
Published Pages 1107-1115
Status Published in-print
DOI 10.1111/nep.13188
URL link to publisher's version