Dietary Egg Whites for Phosphorus Control in Maintenance Haemodialysis Patients: A Pilot Study

Abstract

SUMMARY Background High dietary protein intake is associated with greater survival in maintenance haemodialysis (MHD) patients. High-protein foods may increase dietary phosphorus burden, which is associated with increased mortality in these patients. Hypothesis is: an egg white based diet with low phosphorus to protein ratio (<1.4 mg/g) will lower serum phosphorus without deteriorating the nutritional status in MHD patients. Objective We assessed serum phosphorus and albumin levels in MHD patients who agreed to ingest one meal per day with pasteurised liquid egg whites without phosphorus additives, as principal protein source. Methods Thirteen otherwise stable MHD patients with serum phosphorus >4.0 mg/dl agreed to consume eight ounces (225 g) of pasteurised liquid egg whites one meal per day for six weeks. Recipes were suggested to improve diet variety. Results Thirteen participating patients included seven women, three African Americans and five diabetics. Twelve patients exhibited drop in serum phosphorus. Mean population fall in serum phosphorus was 0.94 mg/dl, i.e. from 5.58 ± 1.34 (mean ± SD) to 4.63 ± 1.18 (p = 0.003). Serum albumin showed an increase by 0.19 g/dl, i.e. from 4.02 ± 0.29 to 4.21 ± 0.36 g/dl (p = 0.014). Changes in phosphorus pill count were not statistically significant (p = 0.88). The egg white diet was well tolerated, and recipe variety appreciated. Conclusion Pasteurised liquid egg whites may be an effective diet component lowering serum phosphorus without risking malnutrition. Controlled trials are indicated to examine egg white based dietary interventions in MHD patients at home or during haemodialysis treatment.

Phosphate Metabolism and Fibroblast Growth Factor 23 in Chronic Kidney Disease

“…Moreover, among animal sources, the proportion of phosphate bioavailability varies greatly. While meat is generally highly digestible and offers high relative bioavailability, red meat and fish contain more phosphate than poultry [152]. Interestingly, the phosphate content in dairy products is variable, with differing phosphate bioavailability across dairy food types (milk vs. cheese) and even within the same class, for example, low-fat vs. whole milk [14].…”

“…Interestingly, the phosphate content in dairy products is variable, with differing phosphate bioavailability across dairy food types (milk vs. cheese) and even within the same class, for example, low-fat vs. whole milk [14]. Further, whole eggs, including the yolk, contain more phosphate than egg whites: one large whole egg contains 6 g of protein and 86 mg of phosphate, whereas an egg white from one large egg contains 4 g of protein and only 5 mg of phosphate [152]. This is one important example of how dietary phosphate and protein can be dissociated, which has important implications for patients undergoing dialysis in whom high protein intake is desirable but must be balanced by avoiding excessive phosphate loading.…”

Patient education for phosphorus management in chronic kidney disease

“…Inorganic phosphorus is present in processed-food additives,11 which are highly absorbable, and is highly abundant in the diet of postmodern industrialized regions 14. Organic phosphorus is found in animal- and plant-derived protein-rich foods; however, the phosphorus-to-protein ratio differs markedly depending on the food source 15. Although plant proteins also contain phosphorus, much plant phosphorus is in the form of less-absorbable phytates 13.…”

Malnutrition, Inflammation and Reverse Epidemiology in Hemodialysis Patients

“…Conversely, two pilot studies have shown promising effects of nutritional supplementation on serum albumin. In one study, maintenance HP consumed eight ounces of egg whites (egg whites are low in phosphorus) once per day for six weeks (Taylor, et al, 2011). Mean serum albumin concentrations increased by 0.19 g/dL along with a fall in mean serum phosphorus of 0.94 mg/dL.…”

“…Recently, studies have investigated the effects of protein and amino acid supplements on serum albumin levels in HP (Bolasco, Caria, Cupisti, Secci, & Saverio Dioguardi, 2011;Moretti, Johnson, & Keeling-Hathaway, 2009;Taylor et al, 2011). When selecting an appropriate nutritional supplement for HP, phosphorus levels must be taken into consideration as it has been demonstrated that high-protein intake with concurrent lowphosphorus ingestion and normal serum phosphorus levels is associated with the lowest mortality rate among HP (Kalantar-Zadeh et al, 2010).…”