J Nutr Health.  2014 Feb;47(1):33-44.

Association of food intake with serum levels of phosphorus and potassium in hemodialysis patients

Affiliations
  • 1Department of Food and Nutrition, Hanyang University, Seoul 133-791, Korea. leess@hanyang.ac.kr
  • 2Department of Nephrology, Seoul Hospital, Hanyang University, Seoul 133-792, Korea.

Abstract

PURPOSE
Elevated serum phosphorus and potassium levels are a major problem for hemodialysis (HD) patients. Hyperphosphatemia and hyperkalemia are closely related to intake of dietary phosphorus and potassium.
METHODS
This study was conducted in order to investigate the effects of food consumed on serum phosphorus and potassium levels in 48 HD patients (20 males and 28 females). We collected anthropometric data, biochemical parameters, and dietary data of the subjects. Dietary data for usual intake were obtained by use of a food-frequency questionnaire (FFQ) consisting of 21 food items.
RESULTS
The mean body mass index (BMI) was 22.2 +/- 3.0 kg/m2, mean serum phosphorus level was 4.50 +/- 1.52 mg/dl, and mean serum potassium level was 4.74 +/- 0.73 mEq/l. Hyperphosphatemia (> 4.5 mg/dl) was found in 45.8% of subjects, and hyperkalemia (> 5.0 mEq/l) in 35.4%. Subjects who took medication only were 56% of total, and those who took medication with dietary therapy were 27%. Patients with medication and dietary therapy showed significantly lower serum phosphorus levels compared to patients with medication only (p < 0.05). Mean duration of HD was 7.9 +/- 7.3 years and it showed positive correlation with serum potassium levels (p < 0.05). Serum phosphorus levels showed positive correlation with intake of mixed grains and soybean milk (p < 0.05). Serum potassium levels showed positive correlation with intake of mixed grains (p < 0.01), potatoes, fish, and high-potassium vegetables (p < 0.05). On the other hand, intake of white rice showed negative correlation with serum potassium levels (p < 0.05).
CONCLUSION
The results of our study suggest that intake of white rice rather than mixed grains is an important factor in sustaining normal serum phosphorus and potassium levels. In addition, limiting intake of soybean milk, potatoes, and fish to under three serving per week is recommended. Finally, conduct of a strict dietary therapy along with medical treatment is desirable because inappropriate food intake increases serum phosphorus and potassium levels to a higher than normal range.

Keyword

hemodialysis; hyperphosphatemia; hyperkalemia; food frequency questionnaire (FFQ)

MeSH Terms

Body Mass Index
Edible Grain
Eating*
Hand
Humans
Hyperkalemia
Hyperphosphatemia
Male
Milk
Phosphorus*
Phosphorus, Dietary
Potassium*
Surveys and Questionnaires
Reference Values
Renal Dialysis*
Solanum tuberosum
Soybeans
Vegetables
Phosphorus
Phosphorus, Dietary
Potassium

Reference

1. Jin DC, Kim NH, Lee SW, Lee JS, Yoon SR, Kim BS. Current renal replacement therapy in Korea - Insan Memorial Dialysis Registry, 2011 - ESRD Registry Committee, Korean Socociety of Nephrology [Internet]. Seoul: Korean Society of Nephrology;2011. cited 2013 Oct 4. Available from: http://www.ksn.or.kr/journal/2012/index.html.
2. Jo WY. Special: management of the complications in hemodialysis patients. Kidney Health. 2002; 3:12–15.
3. Suh MR, Lee EB, Yang WS, Kim SB, Park SK, Lee SK, Park JS, Hong CG. Survival analysis of hemodialysis patients: a single center study. Korean J Nephrol. 2002; 21(4):636–644.
4. Lim IS, Lee GY, Chun SH, Kim GH, Goo JR, Chun RW, Chae DW, Kim HJ, Noe JW. Factors contributing to morbidity and mortality in chronic hemodialysis patients. Korean J Med. 1995; 49(5):683–692.
5. Song KI, Kim SH, Maeng JH, Choi JS. Survival analysis of elderly hemodialysis patients in a single center. Korean J Nephrol. 2003; 22(2):228–236.
6. Ganesh SK, Stack AG, Levin NW, Hulbert-Shearon T, Port FK. Association of elevated serum PO(4), Ca X PO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol. 2001; 12(10):2131–2138.
7. Kovesdy CP, Regidor DL, Mehrotra R, Jing J, McAllister CJ, Greenland S, Kopple JD, Kalantar-Zadeh K. Serum and dialysate potassium concentrations and survival in hemodialysis patients. Clin J Am Soc Nephrol. 2007; 2(5):999–1007.
Article
8. Sehgal AR, Sullivan C, Leon JB, Bialostosky K. Public health approach to addressing hyperphosphatemia among dialysis patients. J Ren Nutr. 2008; 18(3):256–261.
Article
9. Rodriguez DJ, Hunter VM. Nutritional intervention in the treatment of chronic renal failure. Nurs Clin North Am. 1981; 16(3):573–585.
10. Giachelli CM. Vascular calcification mechanisms. J Am Soc Nephrol. 2004; 15(12):2959–2964.
Article
11. Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004; 15(8):2208–2218.
Article
12. Kim OK. Hyperkalemia in chronic renal failure [dissertation]. Gwangju: Chonnam National University;2006.
13. Noori N, Kalantar-Zadeh K, Kovesdy CP, Bross R, Benner D, Kopple JD. Association of dietary phosphorus intake and phosphorus to protein ratio with mortality in hemodialysis patients. Clin J Am Soc Nephrol. 2010; 5(4):683–692.
Article
14. Noori N, Kalantar-Zadeh K, Kovesdy CP, Murali SB, Bross R, Nissenson AR, Kopple JD. Dietary potassium intake and mortality in long-term hemodialysis patients. Am J Kidney Dis. 2010; 56(2):338–347.
Article
15. Kim MY, Suh I, Nam CM, Yoon JY, Shim JS, Oh KW. The development and evaluation of a simple semi-quantitative food frequency questionnaire using the contribution of specific foods to absolute intake and between-person variation of nutrient consumption. Korean J Nutr. 2002; 35(2):250–262.
16. Kalantar-Zadeh K, Kopple JD, Deepak S, Block D, Block G. Food intake characteristics of hemodialysis patients as obtained by food frequency questionnaire. J Ren Nutr. 2002; 12(1):17–31.
Article
17. Korean Dietetic Association. The food exchange list for kidney failure patients. Seoul: Korean Dietetic Association;1997.
18. Lowrie EG, Lew NL. Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis. 1990; 15(5):458–482.
Article
19. Iseki K, Uehara H, Nishime K, Tokuyama K, Yoshihara K, Kinjo K, Shiohira Y, Fukiyama K. Impact of the initial levels of laboratory variables on survival in chronic dialysis patients. Am J Kidney Dis. 1996; 28(4):541–548.
Article
20. Kestenbaum B, Sampson JN, Rudser KD, Patterson DJ, Seliger SL, Young B, Sherrard DJ, Andress DL. Serum phosphate levels and mortality risk among people with chronic kidney disease. J Am Soc Nephrol. 2005; 16(2):520–528.
Article
21. Abe M, Okada K, Soma M. Mineral metabolic abnormalities and mortality in dialysis patients. Nutrients. 2013; 5(3):1002–1023.
Article
22. Kim JH. A study on nutritional management conditions of chronic renal failure patients [dissertation]. Seoul: Ewha Womans University;1992.
23. An HJ. Effects of K and P intervention on improvement of nutritional status in predialysis patients of diabetic nephropathy [dissertation]. Busan: Pusan National University;2008.
24. Seo JY, Kim NH, Heo YR. A study on nutritional status during dialysis in patients undergoing continuous ambulatory peritoneal dialysis. Korean J Nutr. 2012; 45(1):30–43.
Article
25. Nahikian Nelms M, Sucher K, Lacey K, Roth SL. Nutrition intervention. Nutrition Therapy and Pathophysiology. 2nd edition. Belmont (CA): Wadsworth, Cengage Learning;2011. p. 532–536.
26. Kim M, Yang HR, Jeong Y. Mineral contents of brown and milled rice. J Korean Soc Food Sci Nutr. 2004; 33(2):443–446.
27. Lim S, Kang MS, Jwa MK, Song DJ, Oh YJ. Characteristics of cooked rice by adding grains and legumes. J Korean Soc Food Sci Nutr. 2003; 32(1):52–57.
28. Kalantar-Zadeh K, Gutekunst L, Mehrotra R, Kovesdy CP, Bross R, Shinaberger CS, Noori N, Hirschberg R, Benner D, Nissenson AR, Kopple JD. Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease. Clin J Am Soc Nephrol. 2010; 5(3):519–530.
Article
29. The Korean Nutrition Society. Food Values. Seoul: The Korean Nutrition Society;2009.
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