When Is It Alright For Chronic Kidney Disease Patients To Eat Food That May Be High In Phosphorus?


"I'm not itching," one KidneyBuzz.com reader writes, "and I am craving cheesy, Italian food. Is it alright to eat it if my phosphorus numbers appear to be good?" Many people that are on dialysis have to limit their phosphorus intake because they are unable to get rid of high levels of phosphorus (hyperphosphatemia) which often lead to bone disorders; heart disease; development of hard deposits in the heart, arteries, joints, skin or lungs that can be painful or cause serious health problems; bone pain; and severe itching. Hyperphosphatemia has also been linked to overactive parathyroid hormone (PTH) which over time can weaken bones and make them more likely to break and develop renal osteodystrophy (bone mineral deficiency). 

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While Chronic Kidney Disease (CKD) patients should try to balance their phosphorus within their recommended limits, this can be exceedingly difficult as phosphorus is in almost every food. In fact, it is so common that it would be almost impossible to keep safe phosphorus levels just by eating the right foods. Often, CKD patients on dialysis find it exceedingly difficult to avoid all phosphorus found in milk, cheese, pancakes, pizza, and even some breads. Leading Professionals, including those at the second Largest Dialysis Organization (LDO) in the United States, DaVita Inc., are now recommending a "Liberalization of renal diet plans," including reevaluating phosphorus level recommendations. Hence, if you happen to give into temptation and over consume foods that are higher in phosphorus, it is not the end of the world.

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Though you should limit this from happening, there are some things that you can do to protect your health. 
Phosphate Binders: Phosphate binders are drugs that remove the extra phosphorus to your stool and by taking these binders it allows you to choose from a wider range of foods. Talk with your Dietitian about how many phosphate binders you need to take with meals  and snacks as well as if you eat foods higher in phosphorus. Take your binders within 5 to 10 minutes of eating snacks and meals. Take fewer binders with a snack or small meal, and more binders with a big meal or after eating high phosphorus foods. 

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Monitor Eating: You cannot manage phosphorus entirely by just watching what you eat, but it can go a very long way! High amounts of phosphorus are found in high-quality protein foods, like meats and dairy products, and in low-quality protein foods, like nuts and dried beans. Other common high phosphorus foods include cola drinks, chocolate, and processed foods (especially whole-grain cereals). You may need to limit phosphorus in foods to about 800 to 1,200 mg/day while on dialysis. Does this mean you can never eat these foods again? No. If you want a food that is high in phosphorus, try to eat smaller portions, take extra binders, and plan the rest of your food for the day.

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Lab Results: Work with your Dietitian to adjust your eating habits based upon results from your monthly blood test. They are the best indicators of your diet management success.

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More Dialysis: If you find that you are continually exceeding your phosphorus levels, and want to keep your phosphorus within a safe range, you should consider getting more time on dialysis. This may include extending your in center treatment, doing nocturnal dialysis or trying home dialysis. Also, getting a transplant would be the best way to liberalize your diet. 

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"Phosphorus and Chronic Kidney Disease." Http://www.davita.com/. DaVita HealthCare Partners Inc.

"Phosphorus." Http://www.ultracare-dialysis.com/. Fresenius Medical Care Holdings, Inc.