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Clin J Am Soc Nephrol. 2019 Oct 7;14(10):1475-1483. doi: 10.2215/CJN.04250419. Epub 2019 Sep 13.

Short-Term Effects of Very-Low-Phosphate and Low-Phosphate Diets on Fibroblast Growth Factor 23 in Hemodialysis Patients: A Randomized Crossover Trial.

Tsai WC1,2,3,4, Wu HY5,2,6,7,8, Peng YS5,6,7,8, Hsu SP5,6,7, Chiu YL5,6,7,9, Yang JY5,6,7, Chen HY5,6,7, Pai MF5,6,7, Lin WY2, Hung KY6,7, Chu FY10,11,12,13, Tsai SM14, Chien KL15,6,7.

Author information

1
Division of Nephrology, Department of Internal Medicine, klchien@ntu.edu.tw mia23448@gmail.com.
2
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan.
3
Center for General Education, Lee-Ming Institute of Technology, New Taipei City, Taiwan.
4
Department of Marketing and Distribution Management, Oriental Institute of Technology, New Taipei City, Taiwan.
5
Division of Nephrology, Department of Internal Medicine.
6
Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
7
School of Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan.
8
Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei City, Taiwan.
9
Graduate Program in Biomedical Informatics and.
10
Department of Clinical Pathology, and.
11
Department of Medical Laboratory Science and Biotechnology, Yuanpei University of Medical Technology, Hsinchu City, Taiwan; and.
12
Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan City, Taiwan.
13
School of Medical Laboratory Science and Biotechnology, Taipei Medical University, Taipei City, Taiwan.
14
Dietary Department, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
15
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan; klchien@ntu.edu.tw mia23448@gmail.com.

Abstract

BACKGROUND AND OBJECTIVES:

The short-term effects of low-phosphate diets on fibroblast growth factor 23 (FGF23) level and the optimal amount of dietary phosphate restriction in patients undergoing hemodialysis remain unknown.

DESIGN SETTING, PARTICIPANTS, & MEASUREMENTS:

This was a randomized, active-controlled trial with a crossover design that included 35 adults with ESKD undergoing thrice-weekly hemodialysis and with a serum phosphate level >5.5 mg/dl or between 3.5 and 5.5 mg/dl with regular phosphate binder use at a hemodialysis unit of tertiary teaching hospital in Taiwan. Subjects were randomized 1:1 to receive a very-low-phosphate diet, with a phosphate-to-protein ratio of 8 mg/g, or a low-phosphate diet, with a phosphate-to-protein ratio of 10 mg/g for 2 days, each with a 5-day washout during which subjects adhered to their usual diet. The primary outcome measure was mean difference in change-from-baseline intact FGF23 level between intervention groups. Secondary outcomes included difference in change-from-baseline serum phosphate, intact parathyroid hormone (PTH), and C-terminal FGF23 level between intervention groups.

RESULTS:

There was no significant difference in the mean change-from-baseline in intact FGF23 levels between the two study diets. The very-low-phosphate diet significantly lowered serum phosphate (mean difference, 0.6 mg/dl; 95% confidence interval [95% CI], 0.2 to 1.0; P=0.002). There were no significant differences in change-from-baseline intact PTH and C-terminal FGF23 levels between the two study diets.

CONCLUSIONS:

Over the 2-day period, the FGF23-lowering effect of the very-low-phosphate diet is similar to that of the low-phosphate diet. The very-low-phosphate diet has an additional phosphate-lowering effect compared with the low-phosphate diet.

KEYWORDS:

FGF23; Fibroblast Growth Factors; crossover; dialysis; diet; dietary intervention; fibroblast growth factor 23; humans; kidney dialysis; phosphate-to-protein ratio; phosphates; renal dialysis

Comment in

PMID:
31519550
DOI:
10.2215/CJN.04250419

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