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Author Topic: Cutting Dietary Phosphate Doesn't Save Dialysis Patients' Lives, Study Suggests  (Read 2402 times)
Desert Dancer
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« on: January 10, 2011, 06:48:07 AM »

ScienceDaily (Dec. 10, 2010) — Doctors often ask kidney disease patients on dialysis to limit the amount of phosphate they consume in their diets, but this does not help prolong their lives, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN). The results even suggest that prescribing low phosphate diets may increase dialysis patients' risk of premature death.

Blood phosphate levels are often high in patients with kidney disease, and dialysis treatments cannot effectively remove all of the dietary phosphate that a person normally consumes. Because elevated phosphate can lead to serious complications and premature death, dialysis patients are advised to restrict their phosphate intake and/or take phosphate binder medications. Kidney specialists and dietitians have long espoused dietary phosphate restriction; however, there have been few studies of its long-term effects on patient survival and health.

To investigate the issue, Steven Brunelli, MD, MSCE (Brigham and Women's Hospital and Harvard Medical School), Katherine Lynch, MD (Beth Israel Deaconess Medical Center), and their colleagues analyzed data from 1751 patients on dialysis who were followed for an average of 2.3 years. Prescribed daily dietary phosphate was restricted to levels < 870 mg, 871-999 mg, 1000 mg, 1001-2000 mg, and not restricted in 300, 314, 307, 297 and 533 participants, respectively.

The researchers found that patients who were prescribed more restrictive dietary phosphate levels had poorer nutritional status and were more likely to require nutritional supplements. Also, patients with more liberal dietary phosphate restrictions were less likely to die during the study. Specifically, patients prescribed 1001-2000 mg/day were 27% less likely to die and those with no specified phosphate restriction were 29% less likely to die than patients prescribed < 870 mg/day.

When comparing different subgroups of patients, the investigators found a more pronounced survival benefit of liberal dietary phosphate prescription among non-blacks, patients without elevated phosphate levels, and those not taking vitamin D.

"Our data suggest that prescription of low phosphate diets did not improve survival among hemodialysis patients and may, in fact, be associated with greater mortality," said Dr. Brunelli. "In part, this may relate to compromised intake of other essential macronutrients -- such as protein -- that occur unintendedly when low phosphate diets are prescribed, which may offset or supersede any beneficial effects on phosphate mitigation."

Dr. Brunelli noted that these findings apply to naturally occurring phosphate only and do not pertain to foods that are high in phosphate due to phosphate-containing food additives, which were much less abundant in foods at the time the study data were collected (1995-2001). This is very important for several reasons: 1) phosphate additives are now exceedingly common in foods and are present in high doses, 2) additive phosphate is more readily absorbed by the body than naturally occurring phosphate, and 3) foods with intrinsically high phosphate tend to be rich in other nutrients, whereas foods rendered high in phosphate are not necessarily so. Therefore, the effects of foods that are high in phosphate-containing food additives should be investigated in future studies.

Study co-authors include Rebecca Lynch, MS, RD (Brigham and Women's Hospital) and Gary Curhan, MD, ScD (Brigham and Women's Hospital and Harvard Medical School).

Journal Reference:

   1. Steven Brunelli, Katherine Lynch et al. The Association between Prescribed Dietary Phosphate Restriction and Mortality among Hemodialysis Patients. Clinical Journal of the American Society Nephrology, Dec 9, 2010 DOI: 10.2215/CJN.04620510
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August 1980: Diagnosed with Familial Juvenile Hyperurecemic Nephropathy (FJHN)
8.22.10:   Began dialysis through central venous catheter
8.25.10:   AV fistula created
9.28.10:   Began training for Home Nocturnal Hemodialysis on a Fresenius Baby K
10.21.10: Began creating buttonholes with 15ga needles
11.13.10: Our first nocturnal home treatment!

Good health is just the slowest possible rate at which you can die.

The glass is neither half-full nor half-empty. The glass is just twice as large as it needs to be.

The early bird may get the worm but the second mouse gets the cheese.
okarol
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« Reply #1 on: January 10, 2011, 10:56:19 AM »

Related article and discussion here. http://ihatedialysis.com/forum/index.php?topic=21256.0
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Admin for IHateDialysis 2008 - 2014, retired.
Jenna is our daughter, bad bladder damaged her kidneys.
Was on in-center hemodialysis 2003-2007.
7 yr transplant lost due to rejection.
She did PD Sept. 2013 - July 2017
Found a swap living donor using social media, friends, family.
New kidney in a paired donation swap July 26, 2017.
Her story ---> https://www.facebook.com/WantedKidneyDonor
Please watch her video: http://youtu.be/D9ZuVJ_s80Y
Living Donors Rock! http://www.livingdonorsonline.org -
News video: http://www.youtube.com/watch?v=J-7KvgQDWpU
MooseMom
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« Reply #2 on: January 10, 2011, 11:11:40 AM »

I knew it, I knew it, I knew it, I knew it, I knew it!!!
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"Eggs are so inadequate, don't you think?  I mean, they ought to be able to become anything, but instead you always get a chicken.  Or a duck.  Or whatever they're programmed to be.  You never get anything interesting, like regret, or the middle of last week."
Desert Dancer
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« Reply #3 on: January 10, 2011, 05:10:21 PM »

Related article and discussion here. http://ihatedialysis.com/forum/index.php?topic=21256.0

 :oops;
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August 1980: Diagnosed with Familial Juvenile Hyperurecemic Nephropathy (FJHN)
8.22.10:   Began dialysis through central venous catheter
8.25.10:   AV fistula created
9.28.10:   Began training for Home Nocturnal Hemodialysis on a Fresenius Baby K
10.21.10: Began creating buttonholes with 15ga needles
11.13.10: Our first nocturnal home treatment!

Good health is just the slowest possible rate at which you can die.

The glass is neither half-full nor half-empty. The glass is just twice as large as it needs to be.

The early bird may get the worm but the second mouse gets the cheese.
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