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Abstract: PO1735

Restrict Dietary Phosphorus to Decrease Proteinuria and Prevent Decline in Glomerular Filtration Rate in CKD Stages 1 and 2

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1300 Health Maintenance, Nutrition, and Metabolism

Author

  • Saxena, Anita, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Group or Team Name

  • Renal Nutrition Group
Background

Though dietary phosphorus restriction is therapeutic for disordered phosphorus homeostasis, early restriction of dietary phosphorus is not advised in CKD.
Aim: Does early control of dietary phosphorus ameliorates proteinuria, prevent decline in glomerular filtration rate and prevent rise in FGF-23.

Methods

One year longitudinal study on 79 CKD stages 1 and 2 patients. eGFR, serum creatinine , phosphorus, calcium, FGF-23, soluble α-Klotho iPTH FGF 23, blood pressure, were evaluated and compared with 35 controls. 3 days dietary intake was taken using standard methodology on first visit, 6 and 12 months. CKD patients were grouped based on dietary phosphorus intake: Group 1 (n 42): normal phosphorous intake (<1000mg/day) and Group 2 (n=37): high phosphorous intake (>1000mg/d). Patients in Group 2 were educated on high and low phosphorus foods and counselled to adopt a plant-based diet, for low phosphorus absorption with directed diet plan. Data were analysed using SPSS.

Results

At baseline there was no significant difference in the GFR (group1 85.00±18.64 ml/min vs group 2 82.53±16.30ml/min), serum creatinine between groups. In group2 ; GFR, sKlotho, serum phosphorus and FGF-23 correlated significantly with dietary phosphorus intake. In group 2, FGF-23, serum phosphorus, dietary protein and phosphorus intake were significantly higher and sKlotho was significantly lower than group 1. There was significant difference in serum phosphorus (p 0.000), iPTH, (p 0.004), FGF23 (p0.000), Klotho (p0.000), urinary protein (p0.000), dietary protein (Group 1 37.57±3.40; Group 248.79±5.86 p 0.000) and phosphorus (Group 1868.96±69.99 mg/d and Group 2 1312.26±137.57 mg/d p 0.000) intake and dietary phosphorous to protein ratio (p 0.000) between groups 1 and 2. On dietary intervention in group 2 GFR increased p 0.012 from 80.93±15.34 to 84.11±15.38; and to 87.43±18.27 ml/min at 6 and 12 months respectively, Urinary protein declined to 22.01±3.39 mg/mL. FGF 23 declined from 60.67±6.26 to 58.00±7.07 to 53.29±9.48 pg/mL at 12 months. Dietary phosphorus: protein ratio reduced significantly from 27.16±4.35 to 24.75±4.34 p 0.000 at 12 months ((p<0.000) ).Urinary phosphorus excretion increased from 574.37±214.22 to 624.64±137.67 at 12 months.

Conclusion

Restricting dietary phosphorus in stages 1 and 2 can prevent progression of CKD and for control proteinuria.