Association of food intake with serum levels of phosphorus and potassium in hemodialysis patients

Hye Jin Woo; Yeon Joo Lee; Il Hwan Oh; Chang Hwa Lee; Sang Sun Lee

doi:10.4163/jnh.2014.47.1.33

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Woo, Lee, Oh, Lee, and Lee: Association of food intake with serum levels of phosphorus and potassium in hemodialysis patients

Research Article

Journal of Nutrition and Health 2014; 47(1): 33-44.

Published online: 28 February 2014

DOI: https://doi.org/10.4163/jnh.2014.47.1.33

Association of food intake with serum levels of phosphorus and potassium in hemodialysis patients

Hye Jin Woo¹, Yeon Joo Lee¹, Il Hwan Oh², Chang Hwa Lee², Sang Sun Lee¹

¹Department of Food and Nutrition, Hanyang University, Seoul 133-791, Korea.

²Department of Nephrology, Seoul Hospital, Hanyang University, Seoul 133-792, Korea.

To whom correspondence should be addressed. tel: +82-2-2220-1206, leess@hanyang.ac.kr

Received 4 October 2013 Revised 23 October 2013 Accepted 10 December 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Elevated serum phosphorus and potassium levels are a major problem for hemodialysis (HD) patients. Hyperphosphatemia and hyperkalemia are closely related to intake of dietary phosphorus and potassium.

Methods

This study was conducted in order to investigate the effects of food consumed on serum phosphorus and potassium levels in 48 HD patients (20 males and 28 females). We collected anthropometric data, biochemical parameters, and dietary data of the subjects. Dietary data for usual intake were obtained by use of a food-frequency questionnaire (FFQ) consisting of 21 food items.

Results

The mean body mass index (BMI) was 22.2 ± 3.0 kg/m², mean serum phosphorus level was 4.50 ± 1.52 mg/dl, and mean serum potassium level was 4.74 ± 0.73 mEq/l. Hyperphosphatemia (> 4.5 mg/dl) was found in 45.8% of subjects, and hyperkalemia (> 5.0 mEq/l) in 35.4%. Subjects who took medication only were 56% of total, and those who took medication with dietary therapy were 27%. Patients with medication and dietary therapy showed significantly lower serum phosphorus levels compared to patients with medication only (p < 0.05). Mean duration of HD was 7.9 ± 7.3 years and it showed positive correlation with serum potassium levels (p < 0.05). Serum phosphorus levels showed positive correlation with intake of mixed grains and soybean milk (p < 0.05). Serum potassium levels showed positive correlation with intake of mixed grains (p < 0.01), potatoes, fish, and high-potassium vegetables (p < 0.05). On the other hand, intake of white rice showed negative correlation with serum potassium levels (p < 0.05).

Conclusion

The results of our study suggest that intake of white rice rather than mixed grains is an important factor in sustaining normal serum phosphorus and potassium levels. In addition, limiting intake of soybean milk, potatoes, and fish to under three serving per week is recommended. Finally, conduct of a strict dietary therapy along with medical treatment is desirable because inappropriate food intake increases serum phosphorus and potassium levels to a higher than normal range.

Keywords: hemodialysis, hyperphosphatemia, hyperkalemia, food frequency questionnaire (FFQ)

Figures and Tables

Table 1

General characteristics and anthropometric variables of hemodialysis patients

1) Mean ± SD 2) HD: hemodialysis 3) N (%) 4) CKD: chronic kidney disease 5) Medication: Phoslo Tab., Renagel Tab. and Kalimate 6) Post-dialytic weight 7) BMI: body mass index 8) PIBW: percent ideal body weight

^*: p < 0.05, ^***: p < 0.001 by student's t-test or χ²-test

Table 2

Blood parameters of hemodialysis patients

1) Nutrition therapy and pathophysiology, Cengage Learning, Nelms, 2012. 2) Mean ± SD 3) BUN: blood urea nitrogen 4) N (%) ^*: p < 0.05 by ANCOVA between male and female group after adjusting for hemodialysis duration and taking medicine

Table 3

Serum levels of phosphorus and potassium in hemodialysis patients according to general characteristics

1) Mean ± SD 2) HD: hemodialysis 3) Medication: Phoslo Tab., Renagel Tab. and Kalimate

^*: p < 0.05 by ANCOVA after adjusting for hemodialysis duration and taking medicine

Table 4

Serum levels of phosphorus and potassium in hemodialysis patients according to intake of grains and starch food

1) Mean ± SD

^*: p < 0.05, ^**: p < 0.01 by ANCOVA after adjusting for hemodialysis duration and taking medicine. Serving size: bread (100 g), noodles (100 g), rice cake (130 g), potato (130 g), sweet potato (130 g)

Table 5

Serum levels of phosphorus and potassium in hemodialysis patients according to intake of meat, fish, eggs and legumes

1) Mean ± SD 2) Beans cooked in soy sauce.

^*: p < 0.05 by ANCOVA after adjusting for hemodialysis duration and taking medicine. Serving size: meat (60 g), fish (60 g), anchovy (15 g), egg (60 g), tofu (80 g), kong ja ban (20 g), soybean milk (200 ml)

Table 6

Serum levels of phosphorus and potassium in hemodialysis patients according to intake of vegetables, fruits and mushrooms

1) Mean ± SD

^*: p < 0.05 by ANCOVA after adjusting for hemodialysis duration and taking medicine. Serving size: vegetables (70 g), fruits (100 g), mushrooms (30 g)

Table 7

Serum levels of phosphorus and potassium in hemodialysis patients according to nutrient intake

^*: p < 0.05 by ANCOVA between adequate intake and high intake group after adjusting for hemodialysis duration and taking medicine

Table 8

Partial correlation coefficients between serum levels of phosphorus, potassium and general characteristics, food intake, nutrient intake of hemodialysis patients

1) HD: hemodialysis

^*: p < 0.05, ^**: p < 0.01 by Partial Correlations after adjusting for hemodialysis duration and taking medicine

Notes

This work was supported by grants of the National Research Foundation of Korea (2012R1A1A2008077).

References

1. Jin DC, Kim NH, Lee SW, Lee JS, Yoon SR, Kim BS. Current renal replacement therapy in Korea - Insan Memorial Dialysis Registry, 2011 - ESRD Registry Committee, Korean Socociety of Nephrology [Internet]. Seoul: Korean Society of Nephrology;2011. cited 2013 Oct 4. Available from: http://www.ksn.or.kr/journal/2012/index.html.

2. Jo WY. Special: management of the complications in hemodialysis patients. Kidney Health. 2002; 3:12–15.

3. Suh MR, Lee EB, Yang WS, Kim SB, Park SK, Lee SK, Park JS, Hong CG. Survival analysis of hemodialysis patients: a single center study. Korean J Nephrol. 2002; 21(4):636–644.

4. Lim IS, Lee GY, Chun SH, Kim GH, Goo JR, Chun RW, Chae DW, Kim HJ, Noe JW. Factors contributing to morbidity and mortality in chronic hemodialysis patients. Korean J Med. 1995; 49(5):683–692.

5. Song KI, Kim SH, Maeng JH, Choi JS. Survival analysis of elderly hemodialysis patients in a single center. Korean J Nephrol. 2003; 22(2):228–236.

6. Ganesh SK, Stack AG, Levin NW, Hulbert-Shearon T, Port FK. Association of elevated serum PO(4), Ca X PO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol. 2001; 12(10):2131–2138.

7. Kovesdy CP, Regidor DL, Mehrotra R, Jing J, McAllister CJ, Greenland S, Kopple JD, Kalantar-Zadeh K. Serum and dialysate potassium concentrations and survival in hemodialysis patients. Clin J Am Soc Nephrol. 2007; 2(5):999–1007.

8. Sehgal AR, Sullivan C, Leon JB, Bialostosky K. Public health approach to addressing hyperphosphatemia among dialysis patients. J Ren Nutr. 2008; 18(3):256–261.

9. Rodriguez DJ, Hunter VM. Nutritional intervention in the treatment of chronic renal failure. Nurs Clin North Am. 1981; 16(3):573–585.

10. Giachelli CM. Vascular calcification mechanisms. J Am Soc Nephrol. 2004; 15(12):2959–2964.

11. Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004; 15(8):2208–2218.

12. Kim OK. Hyperkalemia in chronic renal failure [dissertation]. Gwangju: Chonnam National University;2006.

13. Noori N, Kalantar-Zadeh K, Kovesdy CP, Bross R, Benner D, Kopple JD. Association of dietary phosphorus intake and phosphorus to protein ratio with mortality in hemodialysis patients. Clin J Am Soc Nephrol. 2010; 5(4):683–692.

14. Noori N, Kalantar-Zadeh K, Kovesdy CP, Murali SB, Bross R, Nissenson AR, Kopple JD. Dietary potassium intake and mortality in long-term hemodialysis patients. Am J Kidney Dis. 2010; 56(2):338–347.

15. Kim MY, Suh I, Nam CM, Yoon JY, Shim JS, Oh KW. The development and evaluation of a simple semi-quantitative food frequency questionnaire using the contribution of specific foods to absolute intake and between-person variation of nutrient consumption. Korean J Nutr. 2002; 35(2):250–262.

16. Kalantar-Zadeh K, Kopple JD, Deepak S, Block D, Block G. Food intake characteristics of hemodialysis patients as obtained by food frequency questionnaire. J Ren Nutr. 2002; 12(1):17–31.

17. Korean Dietetic Association. The food exchange list for kidney failure patients. Seoul: Korean Dietetic Association;1997.

18. Lowrie EG, Lew NL. Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis. 1990; 15(5):458–482.

19. Iseki K, Uehara H, Nishime K, Tokuyama K, Yoshihara K, Kinjo K, Shiohira Y, Fukiyama K. Impact of the initial levels of laboratory variables on survival in chronic dialysis patients. Am J Kidney Dis. 1996; 28(4):541–548.

20. Kestenbaum B, Sampson JN, Rudser KD, Patterson DJ, Seliger SL, Young B, Sherrard DJ, Andress DL. Serum phosphate levels and mortality risk among people with chronic kidney disease. J Am Soc Nephrol. 2005; 16(2):520–528.

21. Abe M, Okada K, Soma M. Mineral metabolic abnormalities and mortality in dialysis patients. Nutrients. 2013; 5(3):1002–1023.

22. Kim JH. A study on nutritional management conditions of chronic renal failure patients [dissertation]. Seoul: Ewha Womans University;1992.

23. An HJ. Effects of K and P intervention on improvement of nutritional status in predialysis patients of diabetic nephropathy [dissertation]. Busan: Pusan National University;2008.

24. Seo JY, Kim NH, Heo YR. A study on nutritional status during dialysis in patients undergoing continuous ambulatory peritoneal dialysis. Korean J Nutr. 2012; 45(1):30–43.

25. Nahikian Nelms M, Sucher K, Lacey K, Roth SL. Nutrition intervention. Nutrition Therapy and Pathophysiology. 2nd edition. Belmont (CA): Wadsworth, Cengage Learning;2011. p. 532–536.

26. Kim M, Yang HR, Jeong Y. Mineral contents of brown and milled rice. J Korean Soc Food Sci Nutr. 2004; 33(2):443–446.

27. Lim S, Kang MS, Jwa MK, Song DJ, Oh YJ. Characteristics of cooked rice by adding grains and legumes. J Korean Soc Food Sci Nutr. 2003; 32(1):52–57.

28. Kalantar-Zadeh K, Gutekunst L, Mehrotra R, Kovesdy CP, Bross R, Shinaberger CS, Noori N, Hirschberg R, Benner D, Nissenson AR, Kopple JD. Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease. Clin J Am Soc Nephrol. 2010; 5(3):519–530.

29. The Korean Nutrition Society. Food Values. Seoul: The Korean Nutrition Society;2009.

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