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TABLE OF CONTENTS INTRODUCTION DIETITIANS RESOURCES VITAMINS PROTEIN MY LABS (SPANISH) MY LABS LAB GUIDE GETTING STARTED SPANISH GETTING STARTED PHOSPHORUS PHOS & K QUIZ POTASSIUM SODIUM FAT DIABETES FLUIDS ABOUT THE PROJECT KDOQI NUTRITION CRN ABOUT US

Phosphorus Education Table of Contents     Phosphorus Vitamin D, Kidney Clinical Trials The Kidney in Cardiovascular Disease NKF K/DOQI Guidelines on Bone Disease Guidelines Phosphorus and calcium are two important minerals that help form and keep bones strong and healthy. These minerals are found in the bloodstream in an inverse or "see-saw" relationship; that is, when one goes up, the other goes down. New studies now indicate that high phosphorus levels contribute to cardiac calcification, a type of heart disease. <More> Phosphorus: A mineral found in all foods and required for normal body function. Primarily found in bone tissue, together with calcium. Normal value = 2..5 -4.7 mg/dL (seniors= 2.3-3.7) Dialysis normal = 4.5-6.0 mg/dL Causes of abnormal levels: LOW: taking too much phosphate binder HIGH: not taking phosphate binders eating high phosphorus foods such as milk, beans, cheese, and organ meats. Signs and symptoms associated with abnormal levels: causes elevated parathyroid hormone by lowering Calcium (Ca); itchy skin Calcium: with phosphorus, is primarily found in bone. Assists in many bodily functions. Normal value = 8.5 - 10.5 mg/dL Dialysis normal = 8.5-11.5 mg/dL Level is best near upper end to avoid overactive parathyroid glands. Causes of abnormal levels: LOW: eating too much high phosphorus food not taking phosphorus binders as recommended HIGH: medications such as Rocaltrol and/or Calderol may cause sharp increase. parathyroid gland removal may be indicated. Calcium level will rise as phosphorus level decreases. Signs and symptoms associated with abnormal levels: LOW: muscle twitching and cramping seizures varying degrees of depression hair loss cataracts conjunctivitus (inflammation of the mucuos membrane of inner eyelid) HIGH: muscle weakness fatigue abdominal cramps loss of appetite nausea and /or vomiting constipation possible coma if left untreated When the kidneys are not functioning properly, the body is not able to use calcium well. This upsets the normal balance and results in too little calcium and too much phosphorus. The body tries to remedy the situation by pulling calcium from the bones. This can lead to itchy skin, bone disease, easily broken bones, bone and joint pain, and can cause deposits in the heart, lungs, blood vessels, and muscles. To restore the proper balance, your doctor may prescribe calcium supplements to replace the calcium that is lost. He may also prescribe Rocaltrol, Calcijex, or Zemplar, an active form of vitamin D, to help with calcium absorption, or he may add calcium to the dialyzing fluid during dialysis. He may also prescribe a medication to bind the phosphorus you eat, which keeps the phosphorus from entering your blood allowing it to pass out of the body in the stool. These phosphorus binders may be antacids like TUMS, or other medications like Phoslo, Basaljel, or Renagel. Some phosphorus binders may cause constipation. If you have a problem with constipation, see the "Fiber" section in this manual for ideas on how to increase fiber in your diet. Talk with your doctor or dietitian if this problem is not resolved soon. REMEMBER! In order to work effectively, you must take your phosphorus binders just before the first bite of food each time you eat a snack or meal. Phosphorus is found in many foods. Dairy products, beans, peas, nuts, cola drinks, whole grain products, and chocolate are especially high in phosphorus. Read over the lists of foods on the next page that are very high and high in phosphorus. Notice that each high phosphorus food has better choices listed to the right. VERY High Phosphorus Foods Dairy Products Milk as a drink Milk in cereal and recipes Soups made with milk Ice cream, frozen yogurt Pudding, yogurt Cheeses: Swiss, Monterey, cheddar, Colby Beans and Peas Beans: pinto, navy, black, lentils, refried, pork åN beans Nuts and Seeds Nuts and seeds, all kinds Peanut butter Better Choices Dairy Products Water, punch, other drinks Non-dairy milk and creamers Soups made with water Sorbet, sherbet, or popsicle Gelatin Cottage cheese, Neufchatel, camembert, brie Beans and Peas Rice dishes Macaroni, spaghetti, noodles Nuts and Seeds Unsalted pretzels, cereal Margarine, cream cheese, jelly High Phosphorus Foods Baked Goods Whole wheat bread, Pumpernickel Whole grain cereals, bran Biscuits Bread, cake, cookie, pancake, biscuit mixes Certain Beverages Dark cola beverages Beer Miscellaneous Molasses Chocolate, coconut, caramel Better Choices Baked Goods White breads, light rye Corn flakes, rice crisps, Rice Chex Dinner rolls Homemade breads, cakes, cookies, pancakes, biscuits Certain Beverages Lemon-lime soda, root beer Wine Miscellaneous Maple syrup Hard candy, jelly beans   Dialyzing Vegetables