ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2023 and some content may be unavailable. To unlock all content for 2023, please visit the archives.

Abstract: TH-PO932

Inorganic Phosphate Additives in US Household 2022 Product Sales from the Top 25 Grocery Store Food Manufacturers: An Existential, Pervasive Risk Factor for CKD

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1500 Health Maintenance, Nutrition, and Metabolism


  • Calvo, Mona S., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Dunford, Elizabeth K., The George Institute for Global Health, Newtown, New South Wales, Australia
  • Uribarri, Jaime, Icahn School of Medicine at Mount Sinai, New York, New York, United States

Restricting dietary phosphorus (P) intake is critical to managing CKD and is an important therapeutic personal action CKD patients can take to slow the progression of kidney failure, hyperphosphatemia and cardiovascular disease. Limiting dietary P intake is not a simple task of consuming less natural food sources rich in P (red meats, dairy) since the use of inorganic phosphate (PO4) additives to process a variety of foods can contribute significant P hidden in processed food. Additives present a unique problem different from natural organic protein and lipid bound P in foods. PO4 additive salts are rapidly dissociated in stomach acidity, absorbed quickly and can acutely disrupt serum P homeostasis and hormonal dysregulation linked to cardiovascular disease and mortality. Control of P intake is further complicated by the unknown extent of exposure to these PO4 additives from packaged food and beverage products.


To estimate exposure to PO4 additives, we examined ingredient labels of US household packaged products from the top 25 food and beverage manufacturers to identify the total number of food products containing PO4 additives across USDA’s 23 food categories. USDA identifies 6 food categories contributing the majority of total P intake (81%); however, this is thought to be mostly natural P as additive contribution is rarely included.


Using category-level sales data as a proxy for actual intake of foods with PO4 additives, we show the % of foods that contained PO4 additives in the 6 categories (Figure). More than 50% of bread, processed meats and ready meals contained PO4 additives. USDA survey intakes of total P are thought to significantly underestimate total P when PO4additive use is not included.


Our findings support this claim of underestimated total P intake, showing evidence of the wide spread use of PO4additives in the foods contributing the most P to daily intake.