Phosphorus is a mineral you need in your diet to survive, but like water and sunlight, too much of this vital substance can harm you. A build-up of phosphorus in the blood, known as hyperphosphatemia, is a condition with severe consequences. Managing hyperphosphatemia can be difficult because the symptoms are not obvious, and each patient is different. According to the American Association of Kidney Patients, “Hyperphosphatemia often has no symptoms, and if undetected, can increase the risk of seizures, stroke, heart attack, and even death.” A 2022 article published in Frontiers in Nutrition connected select types of phosphorus build-up to the occurrences of strokes.
If you are a dialysis patient, you are at a significantly increased risk of having elevated phosphorus because your kidney is no longer able to remove this mineral from your blood. The mere act of having dialysis treatments does not guarantee that phosphorus levels will be controlled, as often that is not the case. “The removal of phosphate during one hemodialysis session amounts to only 800 mg to 1,000 mg. Thus, dialysis 3 times a week is insufficient to remove the recommended daily intake of phosphorus for patients requiring dialysis,” according to the Methodist DeBakey Cardiovascular Journal.
It is important that hyperphosphatemia be diagnosed and dealt with quickly. A report from Frontiers in Medicine explained that “Long-term hyperphosphatemia can lead to symptoms such as pruritus, convulsions, limb ulceration, bone fracture, bone pain, vascular and soft tissue calcification, and hyperparathyroidism, all of which seriously threatens the survival health and life quality of patients.”
Itching and swelling in the feet and ankles are also telltale symptoms that something is wrong. Do not allow these to progress without looking into your phosphorus levels.
The American Association of Kidney Patients also reports that “Approximately 80% of patients on dialysis require phosphate-lowering therapy.” “Management of phosphorus levels in patients receiving dialysis should be achieved through an integrated approach involving dietary control and medical intervention when necessary,” per the Journal of Renal Nutrition.
You must take an active role in managing your phosphorus levels, participating in shared decision-making alongside your doctor. It is important that you know your phosphorus levels so you can and/or prevent problems before they arise. For patients on maintenance dialysis, phosphorus levels are typically measured each month, and it is important that you know your numbers so that you can have informed discussions with your doctor on the best strategy to lower your phosphorus levels toward the normal range.
Work With Your HCP to Maintain Healthy Phosphorus Levels
- Keep track of phosphorous levels and review them with your doctor. Learn the acceptable amount of phosphorus for your age and weight and discuss it with your healthcare practitioner.
- Prevent interactions between your medications. According to the Office of Dietary Supplements from the National Institutes of Health, “Phosphorus can interact with certain medications, and some medications can have an adverse effect on phosphate levels.” Ask your doctor what you can take and should avoid, ensuring your levels are within a safe range.
- Explore complementary therapies. There are new approaches to preserving and improving kidney health. For example, “Assessing cognitive, nutritional and functional status in elderly subjects with CKD is emerging as a new tool to stratify the risk,” per the Journal of Clinical Medicine. Familiarize yourself with what is happening with chronic kidney disease and discuss it with your doctor. If they refuse to explore a therapy option that you feel might work for you, ask them to document it in your chart and provide the reason for the refusal.
- Ask your HCP for a referral to a licensed dietician or nutritionist.
Don’t just accept your doctor’s admonishments and platitudes about your phosphorus levels. Work with them to develop a plan.
Holistic approaches are more successful strategies for managing chronic kidney disease. According to The American Journal of Clinical Nutrition, “Care should be taken in maintenance dialysis patients to avoid concomitant reductions in dietary protein because a low-protein diet can lead to hypoalbuminemia, protein-energy wasting, and uremic malnutrition, which are associated with increased mortality.”
The Journal of Renal Nutrition reinforces that “foods high in phosphorus are plentiful in the normal diet (e.g., meats and fish, nuts, whole grains, legumes, cheese) and contain many important nutrients. Thus, avoiding phosphorus-rich foods can be difficult for patients with CKD, and malnutrition is an important concern in this already nutritionally compromised patient population.”
Know your phosphorus numbers and use them during conversations with your doctor to determine the best methods for developing dietary restrictions to support your goals.
