Managing phosphorus levels in people with CKD

From strengthening bones to activating enzymes, phosphorus is a mineral that the body needs to fulfil many duties. But experts warn that extra phosphorus in the blood can lead to an array of issues including weak bones and calcification in the blood vessels.

The kidneys play an important role in removing excess phosphorus. But in those with Chronic Kidney Disease (CKD), the phosphorous filtration is impaired, and their blood phosphorus concentration rises. People with CKD are often advised to cut down on foods with phosphorus.

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High phosphorus levels and CKD

According to the National Kidney Foundation, extra phosphorus in the blood can pose a danger – it can pull calcium out of the bones and into the blood, making the bones weak.

“Higher phosphorus levels will lead to bone deformity or brittle bones,” says Dr Sanjeev Nair, DM nephrology, professor and head of department, Saveetha Medical College Hospital, Chennai. High levels of calcium in the blood can cause calcification in blood vessels (hardening of the blood vessels) and coronary artery diseases, he adds.

Dr Nair emphasises the importance of checking phosphorus, calcium, and parathyroid levels (parathyroid hormone maintains the optimum level of calcium in the blood) before or after reaching stage 3 of CKD. “The problems caused by increased phosphorus levels in the body will start to manifest within stage 3. Once they have passed stage 3, they must check their levels every three to six months and make any necessary dietary changes based on these levels.”

The dos and don’ts of a low phosphorus diet

Those with CKD must bear in mind that certain dietary changes are necessary to incorporate a low-phosphorus diet. “They must avoid any processed foods such as packet noodles, chips, breakfast cereals etc. They have high amounts of phosphates additives which are unhealthy for the kidneys,” says Suneetha Rao, chief nutritionist, NU Hospitals, Bengaluru.

She mentions that these phosphate additives contain inorganic phosphorus with about 90 per cent phosphorus content. “Our body absorbs inorganic phosphate a lot higher than organic phosphates present in foods,” she says.

Concentrated dairy products must be avoided, says Rao. Condensed milk, homemade yoghurt and kheer (sweet rice pudding) are not recommended; however, you can consume tea and coffee, she says.

Say yes to phosphate binders

Those with CKD who are on dialysis are also prescribed phosphate binders. “They are medications to reduce the phosphate levels in foods that are inevitable in your diet,” says Rao. “There are various kinds of phosphate binders, and they are prescribed depending on each person. Although, side effects like nausea and upset stomach might be seen.”

Rao, however, warns not to follow a diet plan based on internet searches. “People with CKD must ensure that they follow a dietary plan recommended by their renal dietician and not blindly follow myths or what is written on the internet. Dietary planning varies from person to person and depends on the person’s medical history,” she says.

What does a low-phosphorus platter consist of? 

Ashish Goel, 37, an accountant from Chandigarh who has been on dialysis for three and a half years for CKD, is wary of consuming phosphorus in its liquid form. “Dairy products, particularly in liquid form, have high levels of phosphorus that is quickly absorbed by the blood,” he explains.

Goel says that he sticks to a regular diet. “I usually eat parathas and rotis along with sauteed vegetables and chicken to meet my protein needs,” he says.

He mentions how important it is to take phosphate binders along with food, as some foods may have high levels of phosphorus. “Whenever I consume chicken or potatoes, which contain phosphorus, I ensure I have my prescribed phosphorus binders,” he says.

Takeaways

• High levels of phosphorus can lead to bone deformity, calcification of blood vessels and cardiovascular diseases.
• People with CKD must consume a low-phosphorus diet. Their phosphorus levels must be between 3.5 mg/dL to 5.3 mg/dL.
• Phosphate binders are to be consumed as per the doctor’s advice along with a low-phosphorus diet to maintain basic phosphorus levels.