Kenar Jhaveri
Apr 26, 2016 · 2 min read

Phosphorus, diet and ESRD

Hyperphosphatemia and hyperparathyroidism, frequently observed in patients with endstage renal disease, are associated with renal osteodystrophy, organ calcification, cardiovascular disease and sudden death. Restriction of dietary protein and phosphorus is beneficial in slowing the progression of renal failure. Dietary phosphorus restriction must be prescribed at all stages of renal failure in adults. It may be achieved by decreasing protein intake and avoiding foods rich in phosphorus. An average of 60–80% of the phosphorus intake is absorbed in the gut in dialysis patients. If phosphate binders are employed, the phosphorus absorbed from the diet may be reduced to 40%. Dialysis can remove roughly around 900mg of PO4 with each session. Hence dietary control is important to tell your dialysis patients. Around 750 mg of phosphorus intake should be the critical value above which a positive balance of phosphorus may occur. This value corresponds to a protein diet of 45–50 g/day or 0.8 g/kg body weight/day for a 60 kg patient as most of the phosphorus intake is protein related. As early as 1983, studies showed the importance of a low PO4 diet.

The most common top 10 dietary foods that are high in PO4 are listed at the NKF website. But which of these have the highest amounts?

1. Pumpkin and Squash Seeds

2. Cheese (Romano)

3. Fish (Salmon)

4. Shellfish

5. Nuts ( Brazilian)

6. Pork

7. Beef and Veal

8. Low Fat Dairy

9. Soya based food

10. Beans and Lentils

What about hidden foods?

The food industry is adding more phosphate additives to foods that are traditionally considered low-phosphorus foods. The following are a few foods and beverages that now contain hidden phosphorus: Iced teas, sodas, non dairy creamers, flavored waters, enhanced meat products.

Davita provides us with a working list for us to look at when you are shopping. Look for the following ingredients in what you are buying

Phosphoric acid

Sodium polyphosphate


Sodium tripolyphosphate


Tricalcium phosphate


Trisodium phosphate

Dicalcium phosphate

Sodium phosphate

Monocalcium phosphate

Tetrasodium phosphate

Aluminum phosphate


Kenar Jhaveri

Written by

Nephrologist Educator