Improving diet recipe and cooking methods attenuates hyperphosphatemia in patients undergoing peritoneal dialysis

Background and aims: Hyperphosphatemia is an independent predictor for cardiovascular and all-cause mortality in patients undergoing peritoneal dialysis (PD). The study aimed to investigate the effect of dietary intervention on reducing serum phosphate concentration in hyperphosphatemic PD patients. Methods and results: In this single-center clinical trial, 97 prevalent PD patients with serum phosphate concentration >= 1.6 mmol/l were allocated to the intervention (n = 48) or control (n = 49) group and followed up for 1 year. In addition to phosphate binder (calcium carbonate) therapy, patients in the intervention group were intensively educated to reduce phosphate-rich food intake and improve cooking methods. While stable in the control group (1.97 +/- 0.20 to 1.94 +/- 0.35 mmol/l, p > 0.05), the serum phosphate concentration decreased significantly in the intervention group (1.98 +/- 0.28 to 1.65 +/- 0.33 mmol/l, p = 0.015) concurrently with the drop in dietary phosphate intake (13.03 +/- 3.39 to 10.82 +/- 3.00 mg/kg ideal body weight/day, p = 0.001). Moreover, after 6 months of intervention, fewer patients needed to use calcium carbonate (from 64.6% to 41.5%, p = 0.029) and the medicine dose reduced significantly (from 2.25 (0, 3.94) to 0 (0, 1.50) g/day, p < 0.001). Conclusions: Our data indicated that intensive dietary intervention of reducing phosphate-rich food intake and improving cooking methods attenuated hyperphosphatemia in PD patients. It suggests that regular assessment of dietary phosphate intake and modification of diet recipe and cooking methods are essential for hyperphosphatemia treatment in PD patients in addition to phosphate binder therapy. (C) 2015 Elsevier B.V. All rights reserved.