PO4 (Phosphate)

Phosphate control essential for prevention and management of renal bone disease, arterial stiffening and vascular calcification.

Phosphate in the diet generally associated with intake of protein: Meat, fish, chicken, eggs, yoghurts, cheese, milk

Typical UK intakes of phosphate: – Men: 47mmol/day – Women: 36mmol/day

When GFR deteriorates to 25-30ml/min, phosphate retention can occur. Level of restriction depends on treatment mode, residual renal function, dietary intake, and biochemistry. Phosphate not very well dialysed – relatively large ion, with small gradient as plasma concentration low (1-2mmol/l).

Aim to maintain serum phosphate <1.8mmol/l. Control can be achieved via combination of:

Low phosphate diet

  • Limit high phosphate foods (Cheese, yoghurt, eggs, nuts, milk, oily fish)
  • May have to restrict phosphate intake to approx 30mmol/day.
  • However, must maintain adequate protein intake

Phosphate binding medication:
Work in the stomach by binding the phosphate in foods – so should not be taken without food as will have no benefit

  • Calcichew, Phosex (Calcium containing)
  • Renagel, Alucap, Fosrenol, Lanthanum carbonate (Non-calcium containing)