This document provides nutrition information and tips for managing phosphorus levels for those with kidney disease. It lists the serving size and nutrition facts of a cookie, including its phosphorus content. It then gives suggestions for making low-phosphorus food substitutions and advice for taking phosphate binder medications correctly. The document emphasizes the importance of controlling phosphorus levels to prevent bone disease, heart attacks, and other health complications.

1. Nutrition Facts
Serving Size: 1 Cookie (52g)
Serving Per Container: 24
Amount Per Serving
Calories 220 Calories from Fat 80
% Daily Value*
Total Fat 9g 13%
Saturated Fat 5g 25%
Trans Fat 0g
Cholesterol 35mg 11%
Sodium 160mg 6%
Potassium 70mg 2%
Total Carbohydrate
32g
10%
Diatary Fiber 1g 4%
Sugars 17g
Protein 3g
Vitamin A 6% Vitamin C 0%
Calcium 2% Iron 4%
Phosphorus 10%
*Percent Daily Values are based on a 2,000 calorie diet.
Check the ingredients
Can you spot the phosphorus hiding in this
ingredients list?
HINT: There are 3 phosphate additives to find. Answer can be found below.
A lot of phosphorus in food & drinks is hidden in additives.
Be on the look out for any ingredients containing the
letters PHOS. For example:
Phosphoric acid Sodium polyphosphate
Also look out for foods that are fortified with calcium as
these may also contain high levels of phosphorus.
Ingredients: Whole Grain Wheat, Corn Bran, Corn Starch, Sugar,
Corn Syrup, Wheat Bits (whole grain wheat, salt, sugar, sodium
tripolyphosphate), Cinammon, Vitamin E, Phosphoric Acid,
Potassium Hydroxide, Hexametaphosphate, Sodium Selanate
HEALTHY TIPS FOR A LOW PHOSPHORUS
Check the nutrition label
Make simple changes in your food & drink choices
Find references online: www.compact-renal.com/service-center/patient-material/
Vifor Fresenius Medical Care Renal Pharma Ltd. | Vifor Pharma Ltd. | Flughofstrasse 61 – P.O. Box | CH-8152 Glattbrugg Answer: sodium tripolyPHOSphate, PHOSphoric Acid, HexametaPHOSphate
Pale fizzy drinks,
fruit juice instead of
Coca-Cola, ale, beer
Chicken or fish
instead of red meat
Rice milk or soy milk
instead of milk
Black coffee or tea
instead of hot chocolate
Corn or rice cereals
instead of bran, oat or
wheat cereals
Sorbet instead of
ice-cream
Cream cheese or
sour cream
instead of cheese
Green beans, couscous or
popcorn instead of
dried beans, peas or nuts
Sweets
(BUT check additives)
instead of chocolate
Jam, honey or butter
instead of peanut butter
White bread
instead of whole
grain bread
Fresh food instead of
processed food
Serving size & servings per container
tell you how big a portion should be.
Switching to alternatives can help you stay healthy
In general, as a % of DAILY VALUE:
HIGH >10% – Might be best to avoid
MEDIUM 5-10% – Be careful with portion size
LOW <5% – Check portion size
For example: 1 Cookie (52g)
PATIENT MATERIAL
Your dietitian can help you design a
diet that keeps you healthy and that
includes food and drink which you
can both enjoy and afford. !
COMPACT RENAL
COMPREHENSIVE TREATMENT OF HYPERPHOSPHATEMIA

2. Don’t be afraid to
ask questions
Make sure you are clear how many binders you need
to take and when you should take them. Write it down!
Also ask your doctor about any concerns you have
regarding your medication.
For example:
> Why do I need to take phosphate binders?
> How should I expect to feel the first few times
I take them?
> How do I know if phosphate binders are working for me?
Keep your
schedule simple
Make a list of ALL the medications you need to take and
when you need to take them.
> Can you simplify the list? Maybe you can combine times when
you take your medicine, e.g. taking “morning” medicines with
breakfast?
> Consider getting a pill box!
> Check your medication list with your pharmacist or doctor.
Set up reminders
Use mobile phone alarms or sign up for
text messages that alert you when to take
your medication!
Many websites can offer further tips, advice and
support, such as www.scriptyourfuture.org.
If it´s not working out, ask your doctor for help
There are always other options that you can try (maybe a different tablet, a different dose or a new
schedule) so, in order to stay as healthy as possible, always ask for help and don’t just stop taking
your medication.
Stick with
your medication
Phosphate binders won’t make you feel better right after you
take them. You might feel that you can skip a few tablets, or
a week of tablets, and it won’t make much difference.
But, over time, high levels of phosphorus can lead to heart
attacks, strokes or a stay in hospital with bone fractures.
So make a pledge to yourself that you will stick
with your medication!
TIPS TO HELP YOU WITH YOUR
PHOSPHATE BINDERS
PATIENT MATERIAL
?
COMPACT RENAL
COMPREHENSIVE TREATMENT OF HYPERPHOSPHATEMIA
Vifor Fresenius Medical Care Renal Pharma Ltd. | Vifor Pharma Ltd. | Flughofstrasse 61 – P.O. Box | CH-8152 Glattbrugg Find references online: www.compact-renal.com/service-center/patient-material/

3. If your kidneys aren’t functioning properly, phosphorus
can build up in your blood, leading to hyperphosphatemia
(high phosphorus levels).
WHY IS IT IMPORTANT TO CONTROL
YOUR PHOSPHATE LEVELS?
Dialysis, diet & medication all help to
control phosphorus levels
Bone disease & fractures Heart disease
Dialysis alone cannot control phosphorus levels, which is why
doctors also recommend that you follow a well-planned diet and
can prescribe you phosphate binder tablets as well.
A low phosphorus diet helps to reduce your phosphate levels.
Phosphate binder tablets act in stomach and gut binding phosphorus
before it is taken into blood circulation.
High phosphate pulls
calcium from your bones.
The extra calcium from your
bones can end up in your
arteries & heart.
This can make your bones weak and
more likely to break.
This can lead to heart complications,
such as heart attack or stroke.
High phosphorus levels might not cause any symptoms today... …but they store up problems for tomorrow
P
P
P P
P
Ca
Ca
Ca
COMPACT RENAL PATIENT MATERIAL
COMPREHENSIVE TREATMENT OF HYPERPHOSPHATEMIA
P
P
Vifor Fresenius Medical Care Renal Pharma Ltd. | Vifor Pharma Ltd. | Flughofstrasse 61 – P.O. Box | CH-8152 Glattbrugg Find references online: www.compact-renal.com/service-center/patient-material/

4. Healthy tips for low phosphorus
Tips to help with binders
Why is it important to control P?
Check the nutrition label > phosphorus low/medium/high ratio:
Your guide to the new food label: http://www.kidney.org/atoz/content/foodlabel
Check the ingredients > link between calcium fortification & high P:
Cerklewski, Florian L. “Calcium fortification of food can add unneeded dietary phosphorus.” Journal of Food Composition and Analysis
18.6 (2005): 595-598.
Swap food & drink choices
Multiple sources, including:
> Phosphorus in Foods: What to Know When You‘re on a Kidney Diet: http://www.davita.com/kidney-disease/diet-and-nutrition/
diet-basics/phosphorus-in-foods:-what-to-know-when-you%27re-on-a-kidney-diet/e/10253
> USDA nutrient database: http://ndb.nal.usda.gov/
> Low-phosphorus diet: Best for kidney disease? http://www.mayoclinic.org/food-and-nutrition/expert-answers/faq-20058408
> Phosphorus and your CKD diet: http://www.kidney.org/atoz/content/phosphorus
FDA Consumer Update:
http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm164616.htm
CDC Medication Adherence advice (to providers):
http://www.cdc.gov/primarycare/materials/medication/docs/medication-adherence-01ccd.pdf
NICE Guidance (to providers) for improving adherence:
http://www.nice.org.uk/guidance/cg76/chapter/1-guidance
P build-up in bloodstream
Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998; 32:S112.
Pulling calcium from bones
Goltzman, David. “5 Parathyroid Hormone: Its Role in Calcium and Phosphate Homeostasis.” The Physiological Basis of
Metabolic Bone Disease (2014): 103.
Heart complications
Hruska, Keith A., et al. “Hyperphosphatemia of chronic kidney disease.” Kidney International 74.2 (2008): 148-157.
Shanahan, Catherine M., et al. “Arterial calcification in chronic kidney disease: key roles for calcium and phosphate.”
Circulation research 109.6 (2011): 697-711.
Treatment options
Fouque D, Horne R, Cozzolino M, Kalantar-Zadeh K. Balancing nutrition and serum phosphorus in maintenance dialysis.
Am. J. Kidney Dis. 2014;64(1):143-150. doi:10.1053/j.ajkd.2014.01.429.
COMPACT RENAL
COMPREHENSIVE TREATMENT OF HYPERPHOSPHATEMIA REFERENCES
Vifor Fresenius Medical Care Renal Pharma Ltd. | Vifor Pharma Ltd. | Flughofstrasse 61 – P.O. Box | CH-8152 Glattbrugg