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Phospate restiction in renal failure (by low phosphate whey protein powder)
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Phospate restiction in renal failure (by low phosphate whey protein powder)

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  • 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

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