Phosphate control essential for prevention and management of renal bone disease, arterial stiffening and vascular calcification.
Phosphate in the diet generally associated with intake of protein: Meat, fish, chicken, eggs, yoghurts, cheese, milk
Typical UK intakes of phosphate: - Men: 47mmol/day - Women: 36mmol/day
When GFR deteriorates to 25-30ml/min, phosphate retention can occur. Level of restriction depends on treatment mode, residual renal function, dietary intake, and biochemistry. Phosphate not very well dialysed - relatively large ion, with small gradient as plasma concentration low (1-2mmol/l).
Aim to maintain serum phosphate <1.8mmol/l. Control can be achieved via combination of:
Low phosphate diet
- Limit high phosphate foods (Cheese, yoghurt, eggs, nuts, milk, oily fish)
- May have to restrict phosphate intake to approx 30mmol/day.
- However, must maintain adequate protein intake
Phosphate binding medication:
Work in the stomach by binding the phosphate in foods - so should not be taken without food as will have no benefit
- Calcichew, Phosex (Calcium containing)
- Renagel, Alucap, Fosrenol, Lanthanum carbonate (Non-calcium containing)