Phosphorus New Found Impact On The Successful Survival Of Kidney Transplant And Dialysis Patients


Dialysis removes some of the phosphorus from your blood, but it is relatively inefficient as the average hemodialysis treatment removes just 900 to 1,000 milligrams which is less than most Americans consume in one day. It is well known that Chronic Kidney Disease (CKD) patients should maintain their phosphorus levels  between 3.5 and 5.5 milliliters per deciliter (mg/dL) to avoid uncomfortable itching, skin sores, weakened bones and calcified (rigid) blood vessels. However, what most people with CKD may not realize is that high phosphorus levels are directly associated with poor transplant outcomes as well as cardiovascular and all-cause mortality.

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In terms of transplants, high pre-transplant phosphorus levels have been associated with worse outcomes after transplantation according to a study conducted by Dr. Marcelo Santos Sampaio, Harold Simmons Center-UCLA Medical Center. Findings suggest that people with CKD who have phosphorus levels of 7.5 mg/dL or higher have a 1.4 to 2.4 times increased risk of Kidney Transplant failure.  

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Phosphorus levels above the recommended range (3.5 to 5.5 mg/dL) had equally detrimental health outcomes. A more recent study published in the Journal of Renal Nutrition found that levels between 5.5 mg/dL and 6.5 mg/dL were associated with an 18% to 23% increased risk of cardiovascular mortality and as much as a 16% increase of all-cause mortality. Levels that exceeded 6.5 mg/dL but were less than 7.5 mg/dL spiked the risk of a cardiovascular event significantly (37% to 42%) while also increasing the chance of mortality due to other means (26% to 34%).

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The study also showed that low phosphorus (hypophosphatemia) was associated with a significant 28% risk of all-cause mortality among CKD patients, especially those over the age of 65. Hence, CKD patients should balance their phosphorus intake within the recommended levels. The National Kidney Foundation recommends that people with CKD who have phosphorus level greater than 4.5 mg/dL limit their daily phosphorus intake to 800 to 1,000 milligrams per day. Foods high in phosphorus that CKD patients should restrict include dairy products, beer, dark colas, organ meats, processed meats, dried beans/peas, nuts, seeds, bran and whole-grain products. In addition to the foods naturally high in phosphorus, many processed foods are high in the mineral due to phosphate additives so those with CKD should carefully read their food labels and avoid foods with phosphates (PHOS) listed on the ingredient list.

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There are plenty of low-phosphorus foods that you can enjoy. Try unenriched rice milk, cream cheese, sherbet or nondairy creamer instead of traditional dairy products. Also, choose low-sodium soups over cream soups and refined grains over whole-grain varieties. Low-phosphorus fruits and vegetables include grapes, apples, plums, berries, cherries, green beans, asparagus, cucumbers, lettuce, and zucchini. Due to the fact that so many foods contain phosphorous, do not forget to take your recommended phosphate binders with all meals and snacks. If you are concerned about your phosphorus intake encourages you to continually work with your Dietitian to keep your phosphorus in line because it will protect you from the devastating ill effects of out of a phosphorus imbalance.    




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Charnow, Jody A. "High Phosphorus Ups Dialysis Patient Death Risk Regardless of Age." Renal and Urology News

Charnow, Jody A. "High Pretransplant Phosphorus Raises Post-Transplant Death Risk." Renal and Urology News

Bell, Becky. "Phosphorus & Dialysis." LIVESTRONG.COM. Livestrong.