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Erschienen in: Der Nephrologe 1/2013

01.01.2013 | Leitthema

Phosphat und Nahrung

verfasst von: K. Hahn, M.K. Kuhlmann, Prof. Dr. Dr. E. Ritz

Erschienen in: Die Nephrologie | Ausgabe 1/2013

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Zusammenfassung

Bei Dialysepatienten sind hohe Phosphatzufuhr und Hyperphosphatämie verknüpft mit erhöhtem kardiovaskulären Risiko und gesteigerter Mortalität. Neben dem Einsatz von Phosphatbindern oder Hemmern der intestinalen Phosphatabsorption kommt daher der Vermeidung hoher Phosphatzufuhr in Lebensmitteln große Bedeutung zu. Neben dem in Lebensmitteln vorhandenen organisch gebundenen Phosphat (welches nur teilweise absorbiert wird) spielt zunehmend Phosphat als Lebensmittelzusatz eine wichtige Rolle. Die Abschätzung der Phosphatzusätze in kommerziellen Lebensmitteln wird erschwert durch fehlende Angaben zum Phosphatgehalt. Umso wichtiger ist die Schulung und Aufklärung nierenkranker Patienten zur Abschätzung des Phosphatgehalts in Nahrungsmitteln.
Literatur
1.
Zurück zum Zitat Kestenbaum B, Sampson JN, Rudser KD et al (2005) Serum phosphate levels and mortality risk among people with chronic kidney disease. J Am Soc Nephrol 16(2):520–528PubMedCrossRef Kestenbaum B, Sampson JN, Rudser KD et al (2005) Serum phosphate levels and mortality risk among people with chronic kidney disease. J Am Soc Nephrol 16(2):520–528PubMedCrossRef
2.
Zurück zum Zitat Noori N, Kalantar-Zadeh K, Kovesdy CP et al (2010) Association of dietary phosphorus intake and phosphorus to protein ratio with mortality in hemodialysis patients. Clin J Am Soc Nephrol 5(4):683–692PubMedCrossRef Noori N, Kalantar-Zadeh K, Kovesdy CP et al (2010) Association of dietary phosphorus intake and phosphorus to protein ratio with mortality in hemodialysis patients. Clin J Am Soc Nephrol 5(4):683–692PubMedCrossRef
3.
Zurück zum Zitat Dhingra R, Sullivan LM, Fox CS et al (2007) Relations of serum phosphorus and calcium levels to the incidence of cardiovascular disease in the community. Arch Intern Med 167(9):879–885PubMedCrossRef Dhingra R, Sullivan LM, Fox CS et al (2007) Relations of serum phosphorus and calcium levels to the incidence of cardiovascular disease in the community. Arch Intern Med 167(9):879–885PubMedCrossRef
4.
Zurück zum Zitat Sandberg AS, Andersson H, Kivistö B, Sandström B (1986) Extrusion cooking of a high-fibre cereal product. 1. Effects on digestibility and absorption of protein, fat, starch, dietary fibre and phytate in the small intestine. Br J Nutr 55(2):245–254PubMedCrossRef Sandberg AS, Andersson H, Kivistö B, Sandström B (1986) Extrusion cooking of a high-fibre cereal product. 1. Effects on digestibility and absorption of protein, fat, starch, dietary fibre and phytate in the small intestine. Br J Nutr 55(2):245–254PubMedCrossRef
5.
Zurück zum Zitat Sullivan C, Sayre SS, Leon JB et al (2009) Effect of food additives on hyperphosphatemia among patients with end-stage renal disease: a randomized controlled trial. JAMA 301(6):629–635PubMedCrossRef Sullivan C, Sayre SS, Leon JB et al (2009) Effect of food additives on hyperphosphatemia among patients with end-stage renal disease: a randomized controlled trial. JAMA 301(6):629–635PubMedCrossRef
6.
Zurück zum Zitat Moe SM, Zidehsarai MP, Chambers MA et al (2011) Vegetarian compared with meat dietary protein source and phosphorus homeostasis in chronic kidney disease. Clin J Am Soc Nephrol 6(2):257–264PubMedCrossRef Moe SM, Zidehsarai MP, Chambers MA et al (2011) Vegetarian compared with meat dietary protein source and phosphorus homeostasis in chronic kidney disease. Clin J Am Soc Nephrol 6(2):257–264PubMedCrossRef
7.
Zurück zum Zitat Boaz M, Smetana S (1996) Regression equation predicts dietary phosphorus intake from estimate of dietary protein intake. J Am Diet Assoc 96(12):1268–1270PubMedCrossRef Boaz M, Smetana S (1996) Regression equation predicts dietary phosphorus intake from estimate of dietary protein intake. J Am Diet Assoc 96(12):1268–1270PubMedCrossRef
8.
Zurück zum Zitat Uribarri J (2007) Phosphorus homeostasis in normal health and in chronic kidney disease patients with special emphasis on dietary phosphorus intake. Semin Dial 20(4):295–301PubMedCrossRef Uribarri J (2007) Phosphorus homeostasis in normal health and in chronic kidney disease patients with special emphasis on dietary phosphorus intake. Semin Dial 20(4):295–301PubMedCrossRef
9.
Zurück zum Zitat Murphy-Gutekunst L (2005) Hidden phosphorus in popular beverages. Nephrol Nurs J 32(4):443–445PubMed Murphy-Gutekunst L (2005) Hidden phosphorus in popular beverages. Nephrol Nurs J 32(4):443–445PubMed
10.
Zurück zum Zitat Chue CD, Edwards NC, Moody WE et al (2012) Serum phosphate is associated with left ventricular mass in patients with chronic kidney disease: a cardiac magnetic resonance study. Heart 98(3):219–224PubMedCrossRef Chue CD, Edwards NC, Moody WE et al (2012) Serum phosphate is associated with left ventricular mass in patients with chronic kidney disease: a cardiac magnetic resonance study. Heart 98(3):219–224PubMedCrossRef
11.
Zurück zum Zitat Uribarri J, Calvo MS (2003) Hidden sources of phosphorus in the typical American diet: does it matter in nephrology? Semin Dial 16(3):186–188PubMedCrossRef Uribarri J, Calvo MS (2003) Hidden sources of phosphorus in the typical American diet: does it matter in nephrology? Semin Dial 16(3):186–188PubMedCrossRef
12.
Zurück zum Zitat Ohnishi M, Razzaque MS (2010) Dietary and genetic evidence for phosphate toxicity accelerating mammalian aging. FASEB J 24(9):3562–3571PubMedCrossRef Ohnishi M, Razzaque MS (2010) Dietary and genetic evidence for phosphate toxicity accelerating mammalian aging. FASEB J 24(9):3562–3571PubMedCrossRef
13.
Zurück zum Zitat Ellam TJ, Chico TJ (2012) Phosphate: the new cholesterol? The role of the phosphate axis in non-uremic vascular disease. Atherosclerosis 220(2):310–318PubMedCrossRef Ellam TJ, Chico TJ (2012) Phosphate: the new cholesterol? The role of the phosphate axis in non-uremic vascular disease. Atherosclerosis 220(2):310–318PubMedCrossRef
14.
Zurück zum Zitat Zoccali C, Ruggenenti P, Perna A et al (2011) Phosphate may promote CKD progression and attenuate renoprotective effect of ACE inhibition. J Am Soc Nephrol 22(10):1923–1930PubMedCrossRef Zoccali C, Ruggenenti P, Perna A et al (2011) Phosphate may promote CKD progression and attenuate renoprotective effect of ACE inhibition. J Am Soc Nephrol 22(10):1923–1930PubMedCrossRef
15.
Zurück zum Zitat Wahl P, Xie H, Scialla J et al (2012) Earlier onset and greater severity of disordered mineral metabolism in diabetic patients with chronic kidney disease. Diabetes Care 35(5):994–1001PubMedCrossRef Wahl P, Xie H, Scialla J et al (2012) Earlier onset and greater severity of disordered mineral metabolism in diabetic patients with chronic kidney disease. Diabetes Care 35(5):994–1001PubMedCrossRef
16.
Zurück zum Zitat Benavente D, Chue CD, Moore J et al (2012) Serum phosphate measured at 6 and 12 months after successful kidney transplant is independently associated with subsequent graft loss. Exp Clin Transplant 10(2):119–124PubMedCrossRef Benavente D, Chue CD, Moore J et al (2012) Serum phosphate measured at 6 and 12 months after successful kidney transplant is independently associated with subsequent graft loss. Exp Clin Transplant 10(2):119–124PubMedCrossRef
17.
Zurück zum Zitat Di Iorio B, Bellasi A, Russo D; INDEPENDENT Study Investigators (2012) Mortality in kidney disease patients treated with phosphate binders: a randomized study. Clin J Am Soc Nephrol 7(3):487–493CrossRef Di Iorio B, Bellasi A, Russo D; INDEPENDENT Study Investigators (2012) Mortality in kidney disease patients treated with phosphate binders: a randomized study. Clin J Am Soc Nephrol 7(3):487–493CrossRef
18.
Zurück zum Zitat Kalantar-Zadeh K, Gutekunst L, Mehrotra R et al (2010) Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease. Clin J Am Soc Nephrol 5(3):519–530PubMedCrossRef Kalantar-Zadeh K, Gutekunst L, Mehrotra R et al (2010) Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease. Clin J Am Soc Nephrol 5(3):519–530PubMedCrossRef
19.
Zurück zum Zitat Sherman RA, Mehta O (2009) Phosphorus and potassium content of enhanced meat and poultry products: implications for patients who receive dialysis. Clin J Am Soc Nephrol 4(8):1370–1373PubMedCrossRef Sherman RA, Mehta O (2009) Phosphorus and potassium content of enhanced meat and poultry products: implications for patients who receive dialysis. Clin J Am Soc Nephrol 4(8):1370–1373PubMedCrossRef
20.
Zurück zum Zitat Wyshak G (2000) Teenaged girls, carbonated beverage consumption, and bone fractures. Arch Pediatr Adolesc Med 154(6):610–613PubMedCrossRef Wyshak G (2000) Teenaged girls, carbonated beverage consumption, and bone fractures. Arch Pediatr Adolesc Med 154(6):610–613PubMedCrossRef
21.
Zurück zum Zitat Isakova T, Gutierrez O, Shah A et al (2008) Postprandial mineral metabolism and secondary hyperparathyroidism in early CKD. J Am Soc Nephrol 19(3):615–623PubMedCrossRef Isakova T, Gutierrez O, Shah A et al (2008) Postprandial mineral metabolism and secondary hyperparathyroidism in early CKD. J Am Soc Nephrol 19(3):615–623PubMedCrossRef
22.
Zurück zum Zitat Parker BD, Schurgers LJ, Brandenburg VM et al (2010) The associations of fibroblast growth factor 23 and uncarboxylated matrix Gla protein with mortality in coronary artery disease: the Heart and Soul Study. Ann Intern Med 152(10):640–648PubMed Parker BD, Schurgers LJ, Brandenburg VM et al (2010) The associations of fibroblast growth factor 23 and uncarboxylated matrix Gla protein with mortality in coronary artery disease: the Heart and Soul Study. Ann Intern Med 152(10):640–648PubMed
23.
Zurück zum Zitat Fliser D, Kollerits B, Neyer U et al (2007) Fibroblast growth factor 23 (FGF23) predicts progression of chronic kidney disease: the Mild to Moderate Kidney Disease (MMKD) Study. J Am Soc Nephrol 18(9):2600–2608PubMedCrossRef Fliser D, Kollerits B, Neyer U et al (2007) Fibroblast growth factor 23 (FGF23) predicts progression of chronic kidney disease: the Mild to Moderate Kidney Disease (MMKD) Study. J Am Soc Nephrol 18(9):2600–2608PubMedCrossRef
24.
Zurück zum Zitat Isakova T, Xie H, Yang W et al (2011) Fibroblast growth factor 23 and risks of mortality and end-stage renal disease in patients with chronic kidney disease. JAMA 305(23):2432–2439PubMedCrossRef Isakova T, Xie H, Yang W et al (2011) Fibroblast growth factor 23 and risks of mortality and end-stage renal disease in patients with chronic kidney disease. JAMA 305(23):2432–2439PubMedCrossRef
25.
Zurück zum Zitat Gutierrez OM, Mannstadt M, Isakova T et al (2008) Fibroblast growth factor 23 and mortality among patients undergoing hemodialysis. N Engl J Med 359(6):584–592PubMedCrossRef Gutierrez OM, Mannstadt M, Isakova T et al (2008) Fibroblast growth factor 23 and mortality among patients undergoing hemodialysis. N Engl J Med 359(6):584–592PubMedCrossRef
26.
Zurück zum Zitat Hsu HJ, Wu MS (2009) Fibroblast growth factor 23: a possible cause of left ventricular hypertrophy in hemodialysis patients. Am J Med Sci 337(2):116–122PubMedCrossRef Hsu HJ, Wu MS (2009) Fibroblast growth factor 23: a possible cause of left ventricular hypertrophy in hemodialysis patients. Am J Med Sci 337(2):116–122PubMedCrossRef
27.
Zurück zum Zitat Gutiérrez OM, Anderson C, Isakova T et al (2010) Low socioeconomic status associates with higher serum phosphate irrespective of race. J Am Soc Nephrol 21(11):1953–1960PubMedCrossRef Gutiérrez OM, Anderson C, Isakova T et al (2010) Low socioeconomic status associates with higher serum phosphate irrespective of race. J Am Soc Nephrol 21(11):1953–1960PubMedCrossRef
28.
Zurück zum Zitat Shinaberger CS, Kilpatrick RD, Regidor DL et al (2006) Longitudinal associations between dietary protein intake and survival in hemodialysis patients. Am J Kidney Dis 48(1):37–49PubMedCrossRef Shinaberger CS, Kilpatrick RD, Regidor DL et al (2006) Longitudinal associations between dietary protein intake and survival in hemodialysis patients. Am J Kidney Dis 48(1):37–49PubMedCrossRef
29.
Zurück zum Zitat National Kidney Foundation (2003) K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 42(4 Suppl 3):S1–S201 National Kidney Foundation (2003) K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 42(4 Suppl 3):S1–S201
30.
Zurück zum Zitat Sherman RA, Mehta O (2009) Dietary phosphorus restriction in dialysis patients: potential impact of processed meat, poultry, and fish products as protein sources. Am J Kidney Dis 54(1):18–23PubMedCrossRef Sherman RA, Mehta O (2009) Dietary phosphorus restriction in dialysis patients: potential impact of processed meat, poultry, and fish products as protein sources. Am J Kidney Dis 54(1):18–23PubMedCrossRef
31.
Zurück zum Zitat Ketteler M, Westenfeld R, Ritz E (2012) Not all phosphate is created equal. J Ren Nutr 22(6):592–595PubMedCrossRef Ketteler M, Westenfeld R, Ritz E (2012) Not all phosphate is created equal. J Ren Nutr 22(6):592–595PubMedCrossRef
32.
Zurück zum Zitat Bommer J, Ketteler M, Ritz E (2012) Impact of oral calcium on mortality of dialysis patients – an underestimated risk? Nephrol Dial Transplant 27(7):2628–2633PubMedCrossRef Bommer J, Ketteler M, Ritz E (2012) Impact of oral calcium on mortality of dialysis patients – an underestimated risk? Nephrol Dial Transplant 27(7):2628–2633PubMedCrossRef
33.
Zurück zum Zitat Martin KJ, Gonzalez EA (2011) Prevention and control of phosphate retention/hyperphosphatemia in CKD-MBD: what is normal, when to start, and how to treat? Clin J Am Soc Nephrol 6(2):440–446PubMedCrossRef Martin KJ, Gonzalez EA (2011) Prevention and control of phosphate retention/hyperphosphatemia in CKD-MBD: what is normal, when to start, and how to treat? Clin J Am Soc Nephrol 6(2):440–446PubMedCrossRef
34.
Zurück zum Zitat Isakova T, Gutiérrez OM, Chang Y et al (2009) Phosphorus binders and survival on hemodialysis. J Am Soc Nephrol 20(2):388–396PubMedCrossRef Isakova T, Gutiérrez OM, Chang Y et al (2009) Phosphorus binders and survival on hemodialysis. J Am Soc Nephrol 20(2):388–396PubMedCrossRef
35.
Zurück zum Zitat Cupisti A, Morelli E, D’Alessandro C et al (2003) Phosphate control in chronic uremia: don’t forget diet. J Nephrol 16(1):29–33PubMed Cupisti A, Morelli E, D’Alessandro C et al (2003) Phosphate control in chronic uremia: don’t forget diet. J Nephrol 16(1):29–33PubMed
36.
Zurück zum Zitat Gardulf A, Palsson M, Nicolay U (2011) Education for dialysis patients lowers long-term phosphate levels and maintains health-related quality of life. Clin Nephrol 75(4):319–327PubMed Gardulf A, Palsson M, Nicolay U (2011) Education for dialysis patients lowers long-term phosphate levels and maintains health-related quality of life. Clin Nephrol 75(4):319–327PubMed
37.
Zurück zum Zitat Kuhlmann MK (2007) Practical approaches to management of hyperphosphatemia: can we improve the current situation? Blood Purif 25(1):120–124PubMedCrossRef Kuhlmann MK (2007) Practical approaches to management of hyperphosphatemia: can we improve the current situation? Blood Purif 25(1):120–124PubMedCrossRef
38.
Zurück zum Zitat Ahlenstiel T, Pape L, Ehrich JH, Kuhlmann MK (2010) Self-adjustment of phosphate binder dose to meal phosphorus content improves management of hyperphosphataemia in children with chronic kidney disease. Nephrol Dial Transplant 25(10):3241–3249PubMedCrossRef Ahlenstiel T, Pape L, Ehrich JH, Kuhlmann MK (2010) Self-adjustment of phosphate binder dose to meal phosphorus content improves management of hyperphosphataemia in children with chronic kidney disease. Nephrol Dial Transplant 25(10):3241–3249PubMedCrossRef
39.
Zurück zum Zitat Ritz E, Hahn K, Ketteler M et al (2012) Phosphate additives in food – a health risk. Dtsch Arztebl Int 109(4):49–55PubMed Ritz E, Hahn K, Ketteler M et al (2012) Phosphate additives in food – a health risk. Dtsch Arztebl Int 109(4):49–55PubMed
40.
Zurück zum Zitat Faul C, Amaral AP, Oskouei B et al (2011) FGF23 induces left ventricular hypertrophy. J Clin Invest 121(11):4393–4408PubMedCrossRef Faul C, Amaral AP, Oskouei B et al (2011) FGF23 induces left ventricular hypertrophy. J Clin Invest 121(11):4393–4408PubMedCrossRef
41.
Zurück zum Zitat Sehgal A (2011) Food additives: a hidden and preventable source of hyperphosphatemia. ASN Kidney Week Sehgal A (2011) Food additives: a hidden and preventable source of hyperphosphatemia. ASN Kidney Week
Metadaten
Titel
Phosphat und Nahrung
verfasst von
K. Hahn
M.K. Kuhlmann
Prof. Dr. Dr. E. Ritz
Publikationsdatum
01.01.2013
Verlag
Springer-Verlag
Erschienen in
Die Nephrologie / Ausgabe 1/2013
Print ISSN: 2731-7463
Elektronische ISSN: 2731-7471
DOI
https://doi.org/10.1007/s11560-012-0649-4

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