Dietary Phosphorus Restriction for

1
Dietary Phosphorus Restriction for Control of PTH
in CKD
Guideline 4.1. Restriction of Dietary Phosphorus in Patients with CKD
Dietary phosphorus should be restricted to 800-1000 mg/day when the serum phosphorus levels are elevated (gt4.6 mg/dL 1.49 mmol/L at stages 3 and 4 of CKD.
Commentary
The available data and the opinion of the Work Group support the proposal that dietary phosphate restriction should be initiated when blood PTH levels begin to rise (Stage 2) and/or when serum phosphorus levels are elevated at any stage of CKD.
Adapted from National Kidney Foundation. Am J Kidney Dis 200342(4 suppl 3)S2-S201.
2
Risk of Death by Quarterly Varying Phosphorus
3
SPD405-206 Study Change from Baseline in Serum
Phosphorus
4
Calciphylaxis Case Study
Patient 64-year-old man with a history of cryptogenic cirrhosis. Patient 64-year-old man with a history of cryptogenic cirrhosis.
On admission the patient had Worsening liver failure Hypotension Renal failure
Laboratory results
BUN 106 mg/dL (37.8 mmol/L)
Creatinine 3.1 mg/dL (274.0 mmol/L)
Total calcium 6.7 mg/dL (1.67 mmol/L)
Phosphorus 4.8 mg/dL (1.55 mmol/L)
Calcium x phosphorous product 32.2 mg2/dL2 (2.58 mmol2/L2)
Albumin 1.3 g/dL (13 g/L)
Blood, urine, and peritoneal fluid cultures were negative Blood, urine, and peritoneal fluid cultures were negative