Controlling Phosphorous and Beyond

I frequently talk to my patients about keeping phosphorous under control. Some of my patients have wondered why I talk about phosphorous all the time. Well phosphorus is not just a number. High phosphorous levels have been related to bone and heart disease and increased mortality.

Know your phosphate level. Goal phosphate level for CKD (not yet on dialysis) patients is less than 4.5 mg/dl. For dialysis patients, the recommendation is to keep phosphate below 5.5 mg/dl.

Why are we so worried about the elevated phosphate levels?

It has been shown that elevated phosphate level can contribute to bone disease. Not only that, elevated phosphate level can cause calcification of blood vessels and heart valves and can lead to cardiovascular (heart) and peripheral vascular disease (calcification or thickening of blood vessels in the extremities)

High phosphorous can cause calciphylaxis. This is a condition where painful non healing ulcers develop mostly in the extremities.

How can we control phosphate levels?

Dietary restriction of high phosphorous foods. Patients on dialysis should keep their phosphorous intake below 1000 mg/day.

Phosphorous is present in most meats, dairy foods like milk, cheese, yogurt etc. Dark Colas like coke also contain phosphorous. Processed foods are very high in phosphorous. For example if you eat a fast food breakfast sandwich, that can contain up to 450 mg of phosphorous. Dialysis patients need to consume high amounts of protein, therefore it is important to eat meats even though they contain some phosphorous. I would however advise to limit intake of sodas, fast food, cheese etc. Organ meats like beef liver are rich in phophorous. Also nuts and chocolate are high phosphorous foods.

Most dialysis patients need binders to keep their phosphate under control. Examples of phosphate binders are calcium acetate (phoslo),Sevalamer (renagel or renvela), Lanthanum etc. Please remember to take your binders as prescribed. Missing doses of binders is an important cause of high phosphorous in dialysis patients. Please carry binders with you all the time, post reminders on the refrigerator or the microwave to take binders. Also remember binders work only when you take them with your food.

Please work on keeping your phosphorous under control.

Best Wishes

Sushma Pandrangi, MD