Made Dyah Vismita Indramila Duarsa¹, Yenny Kandarini²*, Gede Wira Mahadita² and Ni Nyoman Shinta Prasista Sari¹

¹Bachelor of Medicine and Doctoral Profession Study Program, Faculty of Medicine, Udayana University, Bali
²Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Udayana University, Sanglah Hospital, Bali

*Corresponding Author: Yenny Kandarini, Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali.

Received: October 11, 2021; Published: November 29, 2021

Abstract

Background: Incidence of the chronic kidney disease (CKD) is quite high and is increasing every year. The increase in CKD mortality rate is significantly associated with the increase of the blood phosphate levels, in related to that the control of hyperphosphatemia is one of the main focuses in the management of CKD. A high protein diet has been recommended to prevent malnutrition in CKD patients with hemodialysis. However, a high protein and phosphorus diet has the risk of increasing phosphate levels in the blood circulation of CKD patients. The purpose of this study was to prove that the level of protein and phosphate intake can be used as a determinant of hyperphosphatemia in CKD patients with routine HD.

Methods: Cross-sectional analytic method is used in this research. The research subjects were 66 CKD patients with routine hemodialysis (HD). Subject characteristics, data on phosphorus intake, protein and phosphorus-protein ratio were obtained from a questionnaire food record adapted from the Food and Agriculture Organization of The United Nations. Data on consumption patterns are processed using nutritional survey software to obtain nutritional values.

Results: There was a significant relationship between protein intake and phosphorus intake on hyperphosphatemia in CKD patients. The risk factors for hyperphosphatemia were high phosphorus intake (p = 0.018; OR = 3.886; 95% CI: 1.212-12.460) and adequate protein intake (p = 0.035; OR = 3.674; 95% CI: 1.049-12.865). In this study, there was no significant relationship between phosphorus-protein ratio to the incidence of hyperphosphatemia.

Conclusion: Adequate protein intake and excess phosphorus intake can be used as determinants of hyperphosphatemia in hemodialysis CKD patients with routine HD.

Keywords: Hyperphosphatemia; Protein Intake; Phosphorus Intake; Phosphorus-Protein Ratio; Chronic Kidney Disease; Hemodialysis

References

1. Hill NR., et al. “Global Prevalence of Chronic Kidney Disease – A Systematic Review and Meta-Analysis”. PLOS One 7 (2016): e0158765.
2. Bikbov B., et al. “Disparities in Chronic Kidney Disease Prevalence among Males and Females in 195 Countries: Analysis of the Global Burden of Disease 2016 Study”. Nephrons 4 (2018): 313-318.
3. Zhang L., et al. “Prevalence of chronic kidney disease in China: a cross-sectional survey”. Lancet 9818 (2012): 815-822.
4. Kidney Disease Improving Global Outcome (KDIGO). “KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease”. International Society of Nephrology 1 (2013): 1-150.
5. Barril-Cuadrado G., et al. “Table showing dietary phosphorus/protein ratio for the Spanish population. Usefulness in chronic kidney disease”. Nephrology 3 (2013): 362-371.
6. Kalantar-Zadeh K., et al. “Understanding Sources of Dietary Phosphorus in the Treatment of Patients with Chronic Kidney Disease”. Clinical Journal of the American Society of Nephrology 3 (2010): 519-530.
7. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. “KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD)”. Kidney International 7 (2017): 1-59.
8. Rachmawati TY and Syauqy A. “Relationship of nutritional knowledge with routine energy, protein, phosphor, and potassium intake of chronic kidney disease patients with routine hemodialysis in RSUD Tugurejo Semarang”. Journal of Nutrition College 1 (2014): 271-277.
9. Syauqy A., et al. “Protein and phosphorus intake, phosphorus-protein ratio, and blood phosphorus levels in chronic renal failure patients on hemodialysis”. Jurnal Gizi Indonesia 2 (2012): 58.
10. R RM., et al. “Relationship between Compliance and Pattern of Phosphate-Binding Drug Consumption on Phosphate Levels in Stage V Chronic Kidney Disease”. Maj Kedokt Sriwij 2 (2015): 97-104.
11. Yauri LF., et al. “Overview of calcium and phosphorus products in patients with chronic kidney disease stage V in the Hemodialysis Room of Prof. RSUP. Dr. RD Kandou Manado”. e-ClinicC. 4.2 (2016).
12. Ix JH., et al. “Effect of dietary phosphate intake on the circadian rhythm of serum phosphate concentrations in chronic kidney disease: a crossover study”. American Journal of Clinical Nutrition 5 (2014): 1392-1397.
13. Di Marco GS., et al. “High phosphate directly affects endothelial function by downregulating annexin II”. Kidney International 2 (2013): 213-222.
14. Da J., et al. “Serum Phosphorus and Progression of CKD and Mortality: A Meta-analysis of Cohort Studies”. American Journal of Kidney Diseases 2 (2015): 258-265.
15. Streja E., et al. “Hyperphosphatemia is a combined function of high serum PTH and high dietary protein intake in dialysis patients”. Kidney International 5 (2013): 462-468.
16. Ko GJ., et al. “Dietary protein intake and chronic kidney disease”. Current Opinion in Clinical Nutrition and Metabolic Care 1 (2017): 77-85.
17. Goldstein-Fuchs DJ and LaPierre AF. “Nutrition and Kidney Disease”. Kidney Disease (2014): 467-475.
18. Indonesian Nephrology Association. “Nutrition Consensus in Chronic Kidney Disease”. Indonesian Nephrology Association (2011).
19. Aparicio M., et al. “Keto Acid Therapy in Predialysis Chronic Kidney Disease Patients: Final Consensus”. Journal of Renal Nutrition 2 (2012): S22-S24.

Citation

Citation: Yenny Kandarini., et al. “Protein and Phosphate Intake as Determinants of Hyperphosphatemia in Hemodialysis Patients at Sanglah General Hospital Bali". Acta Scientific Nutritional Health 5.12 (2021): 106-111.

Copyright

Copyright: © 2021 Yenny Kandarini., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.