Help me lower my phosphate

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Help me lower my phosphate

Postby midgetem » Wed Mar 28, 2018 4:23 pm

Hi all

I started heamodialysis about 5 months ago, and have just switched this week to PD.

Anyway when I started dialysis my phosphate level was 3. Since then I have been taking a binder (phone) with every meal / snack and haven't drank any coke, stopped having cereal because of the milk. I cut out lentils, nuts etc hearing they are high in phosphate but for some reason I can't get my level below 2.3.

The rest of my bloods are really good.

Do any of you have any tips on how to get my phosphate levels lower?

Thank you
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Re: Help me lower my phosphate

Postby wagolynn » Thu Mar 29, 2018 4:06 pm

Phosphate target range - 1.1 - 1.7 mmol/l

There are phosphates in fruits, and vegetables, most foods have some.

As Phosphate, and Potassium are water soluble their levels can be brought down by boiling, and discarding the water.
Another way, is to soak the prepared vegetables over night, discarding the soaking water, prior to cooking them.

In the case of Fruits, Apples and Pears are OK, Bananas are a no no, other fruit can be eaten in moderation if you choose the canned (in tins) versions, discarding the liquid.

There are tables for Phosphate, and Potassium content of different foods if you look on the internet.
Armed with these tables you can balance your diet by selecting foods lower in phosphate, and having an occasional high one.

Phosphate binders - the dietician usually prescribes these, they start with a low dose, and encourage you to reduce your phosphate intake, only increasing the dose if the encouragement fails.
The binders often have unpleasant side effects, hence the lowest dose possible for each patient.
There are several different phosphate binders so if you have trouble ask to change to another one.

Hope that helps.
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Re: Help me lower my phosphate

Postby wagolynn » Thu Mar 29, 2018 8:18 pm

Further to the above - The best thing to be doing is to aim at five portions of fruit, and veg per day, (search for five-a-day) this is for your overall health.
The intention being to keep you healthy ready for a transplant, with this in mind, the restrictions on Phosphate, and Potassium should be applied.

If you do make changes to your diet, it is best to keep your medical team informed so they understand the reasons for any changes in blood results.

Rice, Bulgur wheat, Couscous, all make good substitutes for potatoes, reducing potatoes to say two days per week.

The dietary changes are necessary because your kidneys are not controlling Potassium and Phosphate properly any more, and dialysis is very poor at removing both of them.
Both are vital to your health, too little or too much will make you very ill.

This website home page offers a starting point http://www.kidneypatientguide.org.uk/contents.php

Keeping your blood pressure (BP) down is important, high BP destroys kidneys, to this end try to remove salt from your diet, none at the table, and none in cooking, use pepper, herbs, and spices if you miss the salt. (target 120/80)
Look out for salt in processed foods, ready meals, and soft drinks foods.

Clearance (removal of waste products urea etc.) Most dialysis machines show Kt/v on their screens a good clearance is a Kt/v = 1.4

Kt/v
K is a constant for the dialyser you are using.
t is time
v is the estimated volume of water you have. (approx. 60% of weight in males 55% females)

The machine collect the information, and does the calculation the result is a pure number.
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Re: Help me lower my phosphate

Postby midgetem » Fri Mar 30, 2018 4:41 pm

Thanks for this.

I didn't know boiling would remove phosphate. Will start doing that (used to eat a lot of stir fry thinking I was being healthy!) But I guess that's why the dietician told me there is a healthy diet and there is a kidney healthy diet!

Potassium levels at the moment are well controlled. Was 4.2 which is apparently good.

Blood pressure ok. It's 110/80 b but have been told I need to get bottom number closer to 70 so they may put me on blood pressure tablets Soon.

I asked the dietician about table you mentioned and she said she would send a leaflet through the post. Fingers crossed!
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Re: Help me lower my phosphate

Postby wagolynn » Sat Mar 31, 2018 7:11 pm

The point about the diet is dialysis is not very good at removing Phosphat and Potassium, healthy kidneys normall control the levels of these in our bodies, there is some of both in most foods so normally we get for too much but our kidneys dump the excess overboard.

As dialysis will not remove sufficent we must control our intake, that is the reason for the diet.

These website will be of help.

http://dietgrail.com/phosphorus/

http://dietgrail.com/potassium/

This will offer some guidence on blood results, there may be small vairiation between dialysis units and type of dialysis.

http://www.edren.org/pages/handbooks/un ... alysis.php
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Re: Help me lower my phosphate

Postby suzeworld » Fri May 11, 2018 10:09 pm

Why does it matter if your phosphate is high?

I am just learning about this stuff with my dad, who is about to start dialysis. His renal specialist nurse said his phosphates were over 1000 in his urine (edit. I probably mean blood!!). So we went away and looked up phosphates in food, and decided he maybe needed to eat more apples and less banana and nuts ...
But when we asked his consulatant (for diabetes) about this he was pretty dismissive, saying there's phosphate in all foods. He didn't seem too bothered about the high reading my dad has.

Any ideas on that ?
Last edited by suzeworld on Mon May 14, 2018 7:52 pm, edited 1 time in total.
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Re: Help me lower my phosphate

Postby wagolynn » Sat May 12, 2018 1:40 pm

In general we take in, in our food, more phosphates than we need, our, healthy, kidneys removes the excess thus maintaining the correct balance.

Sick kidneys cannot do this so the phosphate level becomes dangerously high, dialysis does not remove much if any phosphates, therefore we have to reduce our phosphate intake by selecting foods low in phosphate, and use phosphate binders, these will be prescribed.
There is a similar situation with potassium.
Also our calcium control system is affected so again we have to make changes to our diet.

More info at http://www.kidneypatientguide.org.uk/contents.php

I dietician will have a talk to him about this, and once on dialysis the dietician will monitor him , and suggest any changes required.
It is a good idea if whoever prepares dad's food goes with him to see the dietician.
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Re: Help me lower my phosphate

Postby suzeworld » Sat May 12, 2018 6:44 pm

Thanks for that.
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Re: Help me lower my phosphate

Postby suzeworld » Mon May 14, 2018 5:26 pm

I just think the diabetes Doc’s attitude was wrong.

Plus I’ve learned there are drugs to BIND phosphates in your gut to keep them out of yr blood, so I guess these can be prescribed if his levels get dangerously high.
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Re: Help me lower my phosphate

Postby wagolynn » Tue May 15, 2018 1:50 pm

Hi suzeworld,

Yes, there are phosphate binders but, as with all drugs, there are side effects, hence it is in the patients interest to keep the usage to a minimum by reducing their intake of phosphates.

It's worth remembering, there are several chemically different phosphate binders, so if a patient is having trouble with one another type can be tried.

The target range on dialysis is 1.1 - 1.7 mmol/l
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Re: Help me lower my phosphate

Postby suzeworld » Wed May 16, 2018 12:32 pm

Thanks.
I realise that I “learned” about these from you, but on my phone I can only see buts if the page!

I think dad was quite interested to find out more about this issue.
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Re: Help me lower my phosphate

Postby wagolynn » Wed May 16, 2018 3:07 pm

Hi suzeworld,
It is very good that dad is interested, the more he understands the better he will feel about it all.

The KPG website is a good starting point but it may raise some questions, if so try on here.
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Re: Help me lower my phosphate

Postby JMan » Fri May 18, 2018 4:41 pm

suzeworld wrote:Why does it matter if your phosphate is high?

I am just learning about this stuff with my dad, who is about to start dialysis. His renal specialist nurse said his phosphates were over 1000 in his urine (edit. I probably mean blood!!). So we went away and looked up phosphates in food, and decided he maybe needed to eat more apples and less banana and nuts ...
But when we asked his consulatant (for diabetes) about this he was pretty dismissive, saying there's phosphate in all foods. He didn't seem too bothered about the high reading my dad has.

Any ideas on that ?


Phosphate is a mineral that binds with calcium. And the main source of natural calcium in the body is.. Bones.. So ongoing high phosphate can lead to brittle bones.. To put it crudely


I've got a little list of books and sites that I tend to share..

One other way is to keep a weeks diary of food and drink and then go over it with a renal dietician.. They may be able to pinpoint.

Also binders need to be taken with drinks and snacks that may be high in phosphate as well. Again the dietician should advise on this.

The other thing is both potassium and phosphate tend to be added as preservatives to many processed foods, ready meals etc (M&S and Iceland tend to have less) with the cheaper supermarkets adding more to reduce cost and increase shelf life. Also phosphate isn't removed very well by dialysis.


Potassium is another topic but equally important as it regulates, among other things Blood Pressure etc.. A very high potassium is dangerous.


Eating Well With Kidney Failure, a Practical Guide and Cookbook
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Eating Well for Kidney Health, Expert Guidance and Delicious Recipes
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Eating Well, Living with Kidney Disease
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Truly Tasty, over 100 recipes created by Irelands Top Chefs for Adults Living with Kidney Disease
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Food With Thought PDF Download or printed copy for £2.50 via the NKF

http://www.kidney.org.uk/help/books/boo ... ththought/

Davita Recipes, an American website with many many recipes.

http://www.davita.com/recipes/
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