Dietary phosphate restriction and protein intake in dialysis patients: a misdirected focus

Efforts at controlling hyperphosphatemia in dialysis patients have been largely unsuccessful. Phosphate removal in thrice-weekly standard dialysis is limited due to the largely time-dependent basis for its removal. Phosphate binders, while highly useful, have not solved the problem. Dietary restriction of phosphate beyond dairy products and a few selected foodstuffs has been underemphasized. This is because of the incorrect belief that substantial reductions in dietary phosphate can only be achieved at the cost of potentially harmful levels of protein restriction. In fact, phosphate-containing food additives are a highly significant source of dietary phosphate and are absorbed to a much greater extent than organic phosphates, making them a target of great therapeutic potential. A considerable reduction in costs, morbidity, and mortality could result from a concerted effort to control this source of dietary phosphate.