Pilot Randomized Controlled Trial of a Standard Versus a Modified Low-Phosphorus Diet in Hemodialysis Patients.

Abstract

INTRODUCTION:

The standard low-phosphorus diet restricts pulses, nuts, and whole grains and other high phosphorus foods to control hyperphosphatemia. We conducted a randomized controlled trial to evaluate the effectiveness, safety, and tolerability of the modified diet, which introduced some pulses and nuts, increased the use of whole grains, increased focus on the avoidance of phosphate additives, and introduced the prescription of low-biological-value protein such as bread.

METHODS:

We conducted a multicenter, pragmatic, parallel-arm, open-label, randomized controlled trial of modified versus standard diet in 74 adults on hemodialysis with hyperphosphatemia over 1 month. Biochemistry was assessed using monthly laboratory tests. Dietary intake was assessed using a 2-day record of weighed intake of food, and tolerability was assessed using a patient questionnaire.

RESULTS:

There was no significant difference in the change in serum phosphate between the standard and modified diets. Although total dietary phosphorus intake was similar, phytate-bound phosphorus, found in pulses, nuts, and whole grains, was significantly higher in the modified diet (P < 0.001). Dietary fiber intake was also significantly higher (P < 0.003), as was the percentage of patients reporting an increase in bowel movements while following the modified diet (P = 0.008). There was no significant difference in the change in serum potassium or in reported protein intake between the 2 diets. Both diets were similarly well tolerated.

CONCLUSION:

The modified low phosphorus diet was well tolerated and was associated with similar phosphate and potassium control but with a wider food choice and greater fiber intake than the standard diet.

• Authors: Fiona N Byrne, Barbara A Gillman, Mairead Kiely, Brendan Palmer, Frances Shiely, Patricia M Kearney, Joyce Earlie, Maria B Bowles, Fiona M Keohane, Pauline P Connolly, Sarah Wade, Theresa A Rennick, Bernice L Moore, Oonagh N Smith, Celene M Sands, Orla Slevin, Denise C McCarthy, Karina M Brennan, Halóg Mellett, Darren Dahly, Eoin Bergin, Liam F Casserly, Peter J Conlon, Kieran Hannan, John Holian, David W Lappin, Yvonne M O'Meara, George J Mellotte, Donal Reddan, Alan Watson, Joseph Eustace
• Journal: Kidney international reports (Kidney Int Rep) Vol. 5 Issue 11 Pg. 1945-1955 (Nov 2020) ISSN: 2468-0249 [Electronic] United States
• PMID: 33163715 (Publication Type: Journal Article)
• Copyright: © 2020 International Society of Nephrology. Published by Elsevier Inc.