Am J Kidney Dis. 2017 Feb;69(2):200-209. doi: 10.1053/j.ajkd.2016.08.029. Epub 2016 Nov 16.

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

Chang AR¹, Miller ER 3rd², Anderson CA³, Juraschek SP⁴, Moser M⁵, White K⁶, Henry B⁵, Krekel C⁵, Oh S⁵, Charleston J², Appel LJ².

Author information

1: Geisinger Health System, Division of Nephrology, Danville, PA. Electronic address: achang@geisinger.edu.
2: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD; Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD.
3: Department of Family and Preventive Medicine, University of California, San Diego, CA.
4: Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD.
5: Institute for Clinical and Translational Research, Johns Hopkins University, Baltimore, MD.
6: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD.

Abstract

BACKGROUND:

Little is known about the effects of phosphorus additives on patients with kidney disease.

STUDY DESIGN:

Randomized, double-blind, crossover trial.

SETTING & PARTICIPANTS:

31 adults with early stages of presumed chronic kidney disease (estimated glomerular filtration rate ≥ 45mL/min/1.73m²; urine albumin-creatinine ratio sex-specific cutoff points: men ≥ 17mg/g, women ≥ 25mg/g).

INTERVENTION:

Higher 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.

OUTCOMES:

Change in 24-hour urine albumin excretion and plasma fibroblast growth factor 23 level.

MEASUREMENTS:

Two 24-hour urine collections and a single fasting blood draw at the end of each period.

RESULTS:

Mean baseline values for phosphorus intake, 24-hour urine phosphorus excretion, and estimated glomerular filtration rate were 1,113±549 (SD) mg/d, 688±300mg/d, and 74.6±22.0mL/min/1.73m². Median urine albumin excretion of 82.7 (IQR, 39.6-174.1) mg/d. Although phosphorus intake from study products increased by 993mg/d (P<0.001) during the higher compared to lower phosphorus additive period, background phosphorus intake decreased by 151mg/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).

LIMITATIONS:

Small sample size, short duration of intervention, changes in background diet during the intervention.

CONCLUSIONS:

A 3-week consumption of higher phosphorus food additives did not significantly increase albuminuria. Further studies are needed to confirm these results.

KEYWORDS:

Phosphorus intake; albuminuria; chronic kidney disease (CKD); diet; fibroblast growth factor 23 (FGF-23); modifiable risk factor; nutrition; parathyroid hormone (PTH); phosphate; proteinuria; randomized controlled trial; urine albumin excretion