'Phos'tering a Clear Message: The Evolution of Dietary Phosphorus Management in Chronic Kidney Disease

Abstract

Phosphorus is a vital nutrient, but disturbances in phosphorus homeostasis are central to chronic kidney disease-mineral and bone disorder. To minimize disturbances, traditional dietary guidance focused on a numerical phosphorus target leading to the exclusion of many healthy foods and implementation challenges. Contemporary phosphorus guidance focuses on dietary source, avoiding additives, and emphasizing low-phosphorus bioaccessibility foods, leading to a more liberal approach. Additional work is needed to demonstrate the efficacy of these contemporary approaches and understand the influence of specific foods, processing, and cooking methods. Unfortunately, patient education using traditional and contemporary strategies may give mixed messages, particularly related to plant-based foods. Thus, greater clarity on the effects of specific foods and dietary patterns may improve phosphorus education. This review aims to discuss the evolution of dietary phosphorus management while highlighting areas for future research that can help move the field toward stronger evidence-based guidance to prevent and treat hyperphosphatemia.

Keywords: Diet; chronic kidney disease; dietary intake; hyperphosphatemia; mineral and bone disorder; phosphorus.

Figure 1:. Phosphorus bioaccessibility qualitative gradient.

Foods can be qualitatively classified as having lower phosphorus bioaccessibility (i.e., plant-based foods), moderate phosphorus bioaccessibility (i.e., animal-based foods), and higher phosphorus bioaccessibility (i.e., foods with phosphorus-containing additives). However, within phosphorus bioaccessibility categories there are factors that may limit or enhance phosphorus bioaccessibility that should be considered.