Pilot Randomized Controlled Trial of a Standard Versus a Modified Low-Phosphorus Diet in Hemodialysis Patients.

Autor:	Byrne FN; Department of Nutrition and Dietetics, Cork University Hospital, Cork, Ireland.; Department of Renal Medicine, Cork University Hospital, Cork, Ireland.; Health Research Board, Clinical Research Facility, Cork, Ireland., Gillman BA; Department of Nutrition and Dietetics, Mater Misericordiae University Hospital, Dublin, Ireland.; Department of Renal Medicine, Mater Misericordiae University Hospital, Dublin, Ireland., Kiely M; School of Food and Nutritional Sciences University College Cork, Cork, Ireland., Palmer B; Health Research Board, Clinical Research Facility, Cork, Ireland.; School of Public Health, University College Cork, Cork, Ireland., Shiely F; Health Research Board, Clinical Research Facility, Cork, Ireland.; School of Public Health, University College Cork, Cork, Ireland., Kearney PM; School of Public Health, University College Cork, Cork, Ireland., Earlie J; Beacon Renal, Tallaght, Dublin, Ireland., Bowles MB; Department of Nutrition and Dietetics, University Hospital Limerick, Limerick, Ireland.; Departments of Nephrology and Internal Medicine, University Hospital Limerick, Limerick, Ireland., Keohane FM; Department of Nutrition and Dietetics, Cork University Hospital, Cork, Ireland.; Department of Renal Medicine, Cork University Hospital, Cork, Ireland., Connolly PP; Department of Nutrition and Dietetics, Cavan General Hospital, Cavan, Ireland.; Department of Medicine, Cavan General Hospital, Cavan, Ireland., Wade S; Department of Nutrition and Dietetics, St. Vincent's University Hospital Dublin, Dublin, Ireland.; Department of Nephrology, St. Vincent's University Hospital Dublin, Dublin, Ireland., Rennick TA; Department of Nutrition and Dietetics, Midland Regional Hospital, Tullamore, Ireland.; Department of Nephrology, Midland Regional Hospital, Tullamore, Ireland., Moore BL; Department of Nutrition and Dietetics, Beaumont Hospital, Dublin, Ireland.; Beaumont Hospital Kidney Center, Beaumont Hospital, Dublin, Ireland., Smith ON; Department of Nutrition and Dietetics, Beaumont Hospital, Dublin, Ireland.; Beaumont Hospital Kidney Center, Beaumont Hospital, Dublin, Ireland., Sands CM; Department of Nutrition and Dietetics, Mayo University Hospital, Mayo, Ireland., Slevin O; Department of Nutrition and Dietetics, Galway University Hospitals, Galway, Ireland.; Department of Nephrology, Galway University Hospitals, Galway, Ireland., McCarthy DC; Northern Cross Dialysis Center, Fresenius Medical Care, Dublin, Ireland., Brennan KM; Beacon Renal Drogheda, Drogheda, Ireland., Mellett H; Department of Nutrition and Dietetics, Tallaght University Hospital, Dublin, Ireland.; Department of Nephrology, Tallaght University Hospital, Dublin, Ireland., Dahly D; Health Research Board, Clinical Research Facility, Cork, Ireland.; School of Public Health, University College Cork, Cork, Ireland., Bergin E; Department of Nephrology, Midland Regional Hospital, Tullamore, Ireland., Casserly LF; Departments of Nephrology and Internal Medicine, University Hospital Limerick, Limerick, Ireland., Conlon PJ; Beaumont Hospital Kidney Center, Beaumont Hospital, Dublin, Ireland., Hannan K; Department of Medicine, Cavan General Hospital, Cavan, Ireland., Holian J; Department of Nephrology, St. Vincent's University Hospital Dublin, Dublin, Ireland., Lappin DW; Department of Nephrology, Galway University Hospitals, Galway, Ireland., O'Meara YM; Department of Renal Medicine, Mater Misericordiae University Hospital, Dublin, Ireland., Mellotte GJ; Department of Nephrology, Tallaght University Hospital, Dublin, Ireland., Reddan D; Department of Nephrology, Galway University Hospitals, Galway, Ireland., Watson A; Department of Nephrology, St. Vincent's University Hospital Dublin, Dublin, Ireland., Eustace J; Department of Renal Medicine, Cork University Hospital, Cork, Ireland.; Health Research Board, Clinical Research Facility, Cork, Ireland.
Jazyk:	angličtina
Zdroj:	Kidney international reports [Kidney Int Rep] 2020 Aug 18; Vol. 5 (11), pp. 1945-1955. Date of Electronic Publication: 2020 Aug 18 (Print Publication: 2020).
DOI:	10.1016/j.ekir.2020.08.008
Abstrakt:	Introduction: The standard low-phosphorus diet restricts pulses, nuts, and whole grains and other high phosphorus foods to control hyperphosphatemia. We conducted a randomized controlled trial to evaluate the effectiveness, safety, and tolerability of the modified diet, which introduced some pulses and nuts, increased the use of whole grains, increased focus on the avoidance of phosphate additives, and introduced the prescription of low-biological-value protein such as bread. Methods: We conducted a multicenter, pragmatic, parallel-arm, open-label, randomized controlled trial of modified versus standard diet in 74 adults on hemodialysis with hyperphosphatemia over 1 month. Biochemistry was assessed using monthly laboratory tests. Dietary intake was assessed using a 2-day record of weighed intake of food, and tolerability was assessed using a patient questionnaire. Results: There was no significant difference in the change in serum phosphate between the standard and modified diets. Although total dietary phosphorus intake was similar, phytate-bound phosphorus, found in pulses, nuts, and whole grains, was significantly higher in the modified diet ( P  < 0.001). Dietary fiber intake was also significantly higher ( P  < 0.003), as was the percentage of patients reporting an increase in bowel movements while following the modified diet ( P  = 0.008). There was no significant difference in the change in serum potassium or in reported protein intake between the 2 diets. Both diets were similarly well tolerated. Conclusion: The modified low phosphorus diet was well tolerated and was associated with similar phosphate and potassium control but with a wider food choice and greater fiber intake than the standard diet. (© 2020 International Society of Nephrology. Published by Elsevier Inc.)
Databáze:	MEDLINE
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