Nutrition, phosphorus, and keto-analogues in hemodialysis patients: a Chinese perspective

The optimal dietary protein requirements in maintenance hemodialysis (HD) patients and how to balance the treatments between the nutritional intervention and other approaches are still controversies among nephrologists. In China, excessive dietary intake, low dose of dialysis, and lack of non-calcium-containing phosphorus binders are the main causes of hyperphosphatemia among HD patients. If the daily protein intake reached the recommended dose of 1.2 g/kg body weight per the Kidney Disease Outcomes Quality Initiative guidelines, the net accumulation of phosphorus in patients receiving conventional thrice-weekly low-flux HD may reach 1550 mg per week on the basis of our studies on the assessment of phosphorus removal by HD and residual renal function. In fact, a relatively low-protein diet supplemented with keto-analogues could maintain the stable nutritional status in dialysis patients and provide additional beneficial effects. An individualized nutritional intervention is worth trying to treat hyperphosphatemia in HD patients.