Phosphorus Consumption Within 1 Hour Prior to Blood Work and Associated Serum Levels of Phosphate, Calcium, and PTH in Adult Patients Receiving Hemodialysis Treatment

Mazzetti, Tom; Hopman, Wilma M.; Christilaw, Erin; Munroe, Jenny; Babiolakis, Corinne; Adams, Michael; Holden, Rachel M.

doi:10.1177/2054358119856891

Cited by 4 publications

(4 citation statements)

References 20 publications

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“…In another study, Mazzetti et al. 23 performed an observational study of serum phosphate levels in routine blood samples from hemodialysis patients, compared patients with and without phosphorus intake during the hour previous to blood sampling, and found serum phosphate to be 0.2 mmol/l higher in the group with phosphorus intake prior to blood sampling. Again, the results are similar to those of our own trial, although the time frame was shorter, and the possible confounders were less well controlled.…”

Section: Discussionmentioning

confidence: 99%

“…The difference in serum phosphate between the 2 meals was just 3%, which is consistent with the results of our own trial. In another study, Mazzetti et al 23 performed an observational study of serum phosphate levels in routine blood samples from hemodialysis patients, compared patients with and without phosphorus intake during the hour previous to blood sampling, and found serum phosphate to be…”

Section: Discussionmentioning

confidence: 99%

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Randomized Trial of Acute Changes in Plasma Phosphate After Phosphorus-Standardized Meals in Peritoneal Dialysis

Lundin

Bressendorff

Kristensen

et al. 2021

Kidney International Reports

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Introduction Hyperphosphatemia is associated with increased morbidity and mortality in patients with chronic kidney disease. The aim of this study was to assess whether a meal with high phosphorus content would affect plasma phosphate in the hours that follow among subjects with end-stage kidney disease on peritoneal dialysis. Methods This was a single-blinded randomized cross-over trial of 12 subjects on maintenance peritoneal dialysis, in which subjects were randomized to consume a meal with either high or low phosphorus content on 2 separate trial days. On each trial day, plasma phosphate was measured immediately before consumption of the standardized meal and after 1, 2, 3, and 5 hours. Results The mean fasting plasma phosphate at baseline was 1.69 ± 0.22 mmol/l. Plasma phosphate was similar between the 2 meals at baseline, as well as at 1, 2, 3, and 5 hours after consumption. The largest observed difference in plasma phosphate between the 2 meals was 0.15 mmol/l, which occurred 5 hours after consumption (high-phosphorus meal 1.75 ± 0.32 mmol/l vs. low-phosphorus meal 1.60 ± 0.14 mmol/l ( P = 0.06)). Using summary analyses for repeated measures, we observed a significant difference in the plasma phosphate between the 2 meals ( P = 0.03). Conclusion Our results show that in subjects with end-stage kidney disease, a meal with high phosphorus content has only a negligible effect on plasma phosphate compared to a meal with low phosphorus content. Thus, large increases in plasma phosphate cannot be accounted for by a high intake of phosphorus in the hours before blood sampling.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Randomized Trial of Acute Changes in Plasma Phosphate After Phosphorus-Standardized Meals in Peritoneal Dialysis

Lundin

Bressendorff

Kristensen

et al. 2021

Kidney International Reports

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“…2,[27][28][29] Specifically, studies have shown that patient adherence to a low phosphorus diet can be increased by consistent education from clinicians. [29][30][31] Another study by Mazzetti and colleagues 32 found that patients who consumed dietary phosphate within 1 h prior to a hemodialysis session experiences alterations in parathyroid hormone levels and had significantly higher serum phosphate values compared to patients who did not consume phosphorus prior to dialysis. 32 These results, combined with our data, illustrate the importance of controlling dietary phosphorus intake to reduce serum phosphate in HD patients.…”

Section: Discussionmentioning

confidence: 99%

Postdialysis serum phosphate equilibrium in hemodialysis patients on a controlled diet and no binders

Stremke

Trevino

Doshi

et al. 2021

Hemodialysis International

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Background: Studies evaluating the change in serum phosphate post hemodialysis (HD) demonstrate an initial decline during dialysis but a rebound post dialysis. However, previous studies were done on usual diet and phosphate binders, with limited number of blood draws, confounding conclusions. We determined serum phosphate reduction, rebound, and equilibrium over 48 h in HD patients consuming a controlled, low phosphorus diet without binders.Methods: Serum phosphate (mg/dL) was analyzed before and after a HD treatment and frequently during the ensuing 48 h intradialytic period in the clinical research unit. Thirteen subjects were enrolled and had been off phosphate binders for 10 days and consumed a standardized low phosphate (900 mg/day) diet for 3 weeks prior to the assessments. Linear regression was used to determine relationships between the pre-HD serum phosphate, decline post-HD (post-HD drop); and a 48 h area under curve (AUC) using the trapezoidal method as a measure of overall phosphate levels from the end of dialysis to 48 h post dialysis. Repeated Measures ANOVA with Dunnett's posthoc test was used to determine rebound. Results: Five of 13 subjects returned to >90% of their pre-HD serum phosphate within the first 24 h post-HD, and serum phosphate was 94 AE 0.11% (range 63%-113%) by 48 h after the completion of HD. The 48 h AUC of serum phosphate during the interdialytic period was correlated with both pre dialysis phosphorus (r = 0.85; p = 0.0002) and the pre-post drop in serum phosphate during dialysis (r = 0.69; p = 0.0085). In contrast, the net ultrafiltration was not related to the 48 h AUC of serum phosphorus (r = 0.20; p = 0.51). Conclusions: In hemodialysis patients on standard low phosphorus diet and no phosphate binders, the interdialytic serum phosphorus level, assessed as AUC, is determined by the pre dialysis phosphorus and net-change in serum phosphorus during the dialysis treatment, but not the ultrafiltration volume [Correction added on 25 January, after first online publication: In the last sentence of the Abstract, the word "potassium" has been replaced with "phosphorus" to improve accuracy.].

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“…Finally the blood samples were taken at various time points during the day and included both fasting and nonfasting samples, which may influence serum phosphate levels. 27,28 Future trials should consider a larger sample size with longer follow-up and more uniform timing of samples.…”

Section: Clinical Researchmentioning

confidence: 99%

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

Byrne

Gillman

Kiely

et al. 2020

Kidney International Reports

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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 ¼ 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.

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Phosphorus Consumption Within 1 Hour Prior to Blood Work and Associated Serum Levels of Phosphate, Calcium, and PTH in Adult Patients Receiving Hemodialysis Treatment

Cited by 4 publications

References 20 publications

Randomized Trial of Acute Changes in Plasma Phosphate After Phosphorus-Standardized Meals in Peritoneal Dialysis

Randomized Trial of Acute Changes in Plasma Phosphate After Phosphorus-Standardized Meals in Peritoneal Dialysis

Postdialysis serum phosphate equilibrium in hemodialysis patients on a controlled diet and no binders

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

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