Phosphorus Additives and Albuminuria in Early Stages of CKD: A Randomized Controlled Trial

详细信息    查看全文

• 作者：Alex R. Chang ; MD ; MS¹ ; ^{achang@geisinger.edu} ; Edgar R. Miller III ; MD ; PhD² ; ³ ; Cheryl A. Anderson ; PhD ; MPH ; MS⁴ ; Stephen P. Juraschek ; MD ; PhD³ ; Melissa Moser ; RD⁵ ; Karen White ; MS ; RD² ; Bobbie Henry ; RD⁵ ; Caitlin Krekel ; MSPH ; RD⁵ ; Susan Oh ; MS ; MPH ; RD⁵ ; Jeanne Charleston ; RN ; BSN² ; ³ ; Lawrence J. Appel ; MD ; MPH² ; ³
• 关键词：Phosphorus intake ; phosphate ; albuminuria ; urine albumin excretion ; proteinuria ; fibroblast growth factor 23 (FGF-23) ; nutrition ; chronic kidney disease (CKD) ; parathyroid hormone (PTH) ; diet ; modifiable risk factor ; randomized controlled trial
• 刊名：American Journal of Kidney Diseases
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：69
• 期：2
• 页码：200-209
• 全文大小：442 K
• 卷排序：69

文摘

Little is known about the effects of phosphorus additives on patients with kidney disease.Study DesignRandomized, double-blind, crossover trial.Setting & Participants31 adults with early stages of presumed chronic kidney disease (estimated glomerular filtration rate ≥ 45 mL/min/1.73 m2; urine albumin-creatinine ratio sex-specific cutoff points: men ≥ 17 mg/g, women ≥ 25 mg/g).InterventionHigher versus lower phosphorus intake for 3 weeks. Higher phosphorus intake was achieved by the addition of commercially available diet beverages and breakfast bars to diet.OutcomesChange in 24-hour urine albumin excretion and plasma fibroblast growth factor 23 level.MeasurementsTwo 24-hour urine collections and a single fasting blood draw at the end of each period.ResultsMean baseline values for phosphorus intake, 24-hour urine phosphorus excretion, and estimated glomerular filtration rate were 1,113 ± 549 (SD) mg/d, 688 ± 300 mg/d, and 74.6 ± 22.0 mL/min/1.73 m2. Median urine albumin excretion of 82.7 (IQR, 39.6-174.1) mg/d. Although phosphorus intake from study products increased by 993 mg/d (P < 0.001) during the higher compared to lower phosphorus additive period, background phosphorus intake decreased by 151 mg/d (P = 0.004). Higher phosphorus additive consumption increased 24-hour urine phosphorus excretion by 505 (95% CI, 381 to 629) mg/d (P < 0.001), but did not significantly increase albuminuria (higher vs lower: 14.3%; 95% CI, −2.5% to 34.0%; P = 0.1) or fibroblast growth factor 23 level (higher vs lower: 3.4%; 95% CI, −5.9% to 13.6%; P = 0.4).LimitationsSmall sample size, short duration of intervention, changes in background diet during the intervention.ConclusionsA 3-week consumption of higher phosphorus food additives did not significantly increase albuminuria. Further studies are needed to confirm these results.