Phosphorus additives in food and their effect in dialysis patients.
Phosphorus additives in food and their effect in dialysis patients.
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DOI：
10.2215/cjn.03950609
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发表时间：
2009-08
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影响因子：
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通讯作者：
J. Uribarri
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作者：
J. Uribarri
有大量流行病学证据表明透析患者中高磷血症与心血管和全因死亡率存在关联 (1,2)。因此，控制高磷血症是透析患者常规临床护理的关键要素。理论上，血清磷水平的控制可以通过减少膳食磷摄入量、减少磷结合剂对胃肠道磷的吸收以及通过透析增加磷消除的正确组合来实现。然而，临床现实是，尽管广泛使用高效透析器、新型磷结合剂和常规营养教育，但透析患者的平均血清磷仍然高于实践指南推荐的水平，长期夜间血液透析的患者除外(3)。执业肾脏病学家普遍缺乏对膳食磷限制的关注，更具体地说，缺乏对增加富含磷酸盐添加剂的加工食品的消费的认识，可能会极大地限制当前干预措施的功效(4)。估算膳食磷摄入量不仅要考虑天然食品中所含的磷，还要考虑加工食品中添加的磷。一般来说，肉类、牛奶、鸡蛋和谷物等富含蛋白质的食物天然磷含量也很高，传统上是膳食磷的主要来源 (5)。然而，这种情况正在发生变化，因为磷酸盐目前被添加到大量且数量不断增加的加工食品中，包括肉类、奶酪、调味品、饮料和烘焙产品 (6-8)。因此，根据食物的选择，此类添加剂可能会使磷的摄入量增加多达 1.0 克/天 (7)。添加剂中的磷比天然高磷食品中的磷更容易被吸收；因此，添加剂对高磷血症的影响比等量的天然......
There is substantial epidemiologic evidence linking hyperphosphatemia and cardiovascular and all-cause mortality among dialysis patients (1,2). Therefore, control of hyperphosphatemia is a crucial element of the routine clinical care of dialysis patients. Theoretically, control of serum phosphorus levels can be achieved by the right combination of decreased dietary phosphorus intake, decreased GI phosphorus absorption by phosphate binders, and increased phosphorus elimination via dialysis. However, the clinical reality is that despite the widespread use of high-efficiency dialyzers, new phosphorus binders, and usual nutritional education, the average serum phosphorus in dialysis patients remains higher than the levels recommended by practice guidelines, except in patients on long nocturnal hemodialysis (3). The lack of attention by practicing nephrologists to dietary phosphorus restriction in general, and more specifically the lack of awareness regarding the increasing consumption of processed foods rich in phosphate additives, may significantly contribute to limit the efficacy of the current interventions (4). Estimation of the dietary intake of phosphorus should consider not only phosphorus contained in natural food, but also phosphorus added in processing food. In general, foods high in protein like meats, milk, eggs, and cereals are also naturally high in phosphorus and traditionally have represented the main source of dietary phosphorus (5). However, this is changing as phosphates are currently being added to a large and increasing number of processed foods, including meats, cheeses, dressings, beverages, and bakery products (6–8). As a result, and depending on the food choices, such additives may increase the phosphorus intake by as much as 1.0 g/d (7). Phosphorus in additives is more readily absorbed than that from foods naturally high in phosphorus; as a result, additives will have a greater effect on hyperphosphatemia than an equivalent amount of naturally …