PHOSPHORUS AND

DIALYSIS
EVIDENCE BASED MEDICINE
EMILY WALKER

EVIDENCE BASED MEDICINE

EVIDENCE BASED MEDICINE requires integration of
the best research evidence with clinical expertise,
and the patients unique values and circumstances
Evidence from clinical research studies, trials
From credible journals- the higher the impact factor the better.

Purpose is to improve patient outcomes by

providing clinicians with the highest grade
evidence available
Pros: results have been shown in a large number of
people
Cons: Individuals are different, funding source

PHOSPHORUS
What is Phosphorus?
Main function: Bones and Teeth
Plays an important role in how
the body uses CHOs and Fats
Needed in order to make
protein for growth,
maintenance, and repair
Muscle contractions
Normal heartbeat
Nerve Signaling.
KIDNEY FUNCTION

Foods containing
Phosphorus..
Naturally
Occurring

Added

PHOSPHORUS AND KIDNEY FUNCTION

Unhealthy kidneys are no longer able to remove
phosphorus from the blood and get rid of the
excess in urine.
Patients with stage 4 and 5 (end stage renal
disease) have high levels of phosphorus build up in
their bodies

HYPERPHOSPHATEMIA
Health risks.
bone and heart problems that lead to hospital stays and in
some cases death
too much PTH to be released, which over time can weaken
bones and make them more likely to break and develop
renal osteodystrophy
low blood calcium, which causes calcium to be taken from
the bones
calcification or hardening of tissues when phosphorus and
calcium form hard deposits in the heart, arteries, joints, skin
or lungs that can be painful and lead to serious health
problems

PHOSPHORUS AND DIALYSIS

Hemodialysis: Hemodialysis removes only a small
amount of phosphorus from the blood. Phosphorus
builds up between treatments. Foods high
in phosphorus must be limited in the diet, and
medicines called phosphorus binders used.

Peritoneal
Dialysis: Phosphorus is not
removed well during
peritoneal dialysis, so PD
patients need to limit
phosphorus in their diets.

EVALUATION OF A MINERAL METABOLISM

PROTOCOL IN PERITONEAL DIALYSIS
PATIENTS

Level of Evidence: A
Objective: To determine if there is an improvement in
the number of PD patients who meet target goals for
serum phosphorus and parathyroid hormone after
the implementation of a dietitian led mineral
metabolism protocol
As hyperphosphatemia develops, parathyroid hormone is
stimulated beyond the bodys ability to continue its regular
negative feedback mechanism

Design: Retrospective, comparative, analytic study

Subjects: 140 patients from 2009 and 139 patients
from 2011 stable on PD for minimum 3 months

STUDY DETAILS
Dietitian developed mineral protocol consists of an
algorithm and pre printed orders that allow the
dietitian to make adjustments to phosphorus binders
and vitamin D analogs
Results: After 6 months of the protocol being
initiated, there was no significant difference in the
number of patients meeting serum phosphate
targets- however a significant increase in the
number of patients who met target iPTH range.
Recommendations: Implement mineral plan to
control iPTH levels and avoid hyperparathryroidism

UNDERSTANDING THE ASSOCIATIONS

BETWEEN MODIFYING FACTORS,
INDIVIDUAL HEALTH BENEFITS AND
HD PATIENTS ADHERENCE TO A LOW
PHOSPHORUS DIET
Level of evidence: B
Design: Cross Sectional Survey
95 subjects age 18 or older on HD without dementia or
developmental delay
Objective: Hyperphosphatemia in end-stage renal disease is
associated with significant morbidity and mortality. Because
phosphorus is not effectively dialyzed, dietary adherence
remains a significant problem. Previous studies have
examined the health belief model, but none have looked at
stages of change and dietary adherence in patients
undergoing hemodialysis (HD).

RESULTS
Results: Ninety-five patients completed the survey;
59 (62%) endorsed adherence to a low-phosphorus
diet and 32 (34%) had phosphorus values <5.5
mg/dL.
Modifying factors associated with diet adherence
included nonminority status odds ratio, greater level
of education, better quality of life, and time on
dialysis.
Individual health beliefs associated with diet
adherence included perceived benefits and selfefficacy.

CONCLUSIONS
Hemodialysis clinicians and educators may obtain
better results with dietary adherence and
phosphorus control if they focus not only toward
disease and dietary education but also on
understanding modifying factors and individual
health beliefs
Use stages of change model
Self efficacy

CONCEPTUAL MODEL OF LOW

PHOSPHORUS DIET ADOPTION

REFERENCES
"Potassium, Phosphorus and the Dialysis Diet." Potassium
Foods, Phosphorus Foods and the Dialysis Diet. N.p., n.d. Web.
02 Nov. 2014.
"Phosphorus in Diet: MedlinePlus Medical Encyclopedia." U.S
National Library of Medicine. U.S. National Library of Medicine,
n.d. Web. 02 Nov. 2014.
"Understanding the Associations Between Modifying Factors,
Individual Health Beliefs, and Hemodialysis Patients
Adherence to a Low-Phosphorus Diet. Journal of Renal
Nutrition (2014). Web. Journal of Renal Nutrition
"Evaluation of a Mineral Metabolism Protocol in Peritoneal
Dialysis Patients" Journal of Renal Nutrition. 24.6 (2014). Web