Helical noncontrast-enhanced CT showing calcification involving

the left main coronary artery.

Example of Coronary Calcification

Age, yDietary Calcium

Limit, mg/d19-30 250031-50 250051-70 2000> 70 2000

IOM website.[1]

Upper Level Calcium Intake: Adults

*Many raw meats now contain phosphate additives to enhance their flavor. Phosphorus content may vary depending on the product brand or manufacturer.

Sullivan K, et al. J Renal Nutr. 2007;17:350-354[3]; NKF. 2014[4]; Kalanter-Zadeh RA, et al. Clin J Am Soc Nephrol 2010;5:519-530[5]; Sherman RA, et al. Clin J Am Soc Nephrol. 2009;4:1370-1373.[6]

Phosphorus in FoodsPhosphorus-Rich Foods

Phosphorus Level, mg

Lower-Phosphorus Substitutes

Phosphorus Level, mg

Chicken breast, breaded, flavor-enhanced (3.5 oz)*

242 Chicken breast, fresh, not flavor-enhanced (3.5 oz)

182

Pork chop, flavor-enhanced (3.5 oz)*

340 Pork chop, not flavor-enhanced (3.5 oz)

210

Milk (8 oz) 230 Nondairy creamer (8 oz) 100Peanuts (2 oz) 200 Popcorn (1.5 c) 35Hard cheese (1 oz) 145 Cream cheese (1 oz) 30Oatmeal (2/3 c) 130 Cream of wheat or grits

(2/3 c)40

Pinto beans (1/2 c) 100 Green beans (1/2 c) 35Ice cream (1/2 c) 80 Sherbet (1/2 c) 0Egg (1 large) 72 Egg white (1 large) 5Dark cola (12 oz) 55 Ginger ale (12 oz) 3

Phosphate Binder Available FormsAluminum hydroxide* Liquid, capsule, tabletCalcium acetate† Capsule, tabletCalcium carbonate† Liquid, tablet, capsule, chewable, gumLanthanum carbonate Wafer, chewableSevelamer hydrochloride TabletSevelamer carbonate Tablet, powderSucroferric oxyhydroxide Tablet

*Prolonged administration may increase the risk for aluminum intoxication.†May increase risk of soft-tissue calcification.

KDIGO. CKD-MBD Work Group. Kidney Int. 2009;76:S1-S130.[2]

Phosphate Binders Commonly Used to Manage Hyperphosphatemia in Patients With CKD

Patient Education Resources

Sources (clockwise from left): Medscape Education [7]; USDHHS. 2009. Reproduced with permission.[8]; NKDEP. 2012. Reproduced with permission.[9]; NKDEP. 2010. Reproduced with permission.[10]

Making Food Choices

• Convenience and fast foods often contain phosphorus additives

• The breading on many fried foods may substantially increase phosphorus content

• Dietitians should work closely with patients to help them make appropriate food choices

Sullivan K, et al. J Renal Nutr. 2007;17:350-354.[3]

Kalanter-Zadeh RA, et al. Clin J Am Soc Nephrol 2010;5:519-530[5]

• Dicalcium phosphate• Disodium phosphate• Monosodium phosphate• Phosphoric acid• Sodium hexameta-phosphate• Sodium tripolyphosphate• Tetrasodium pyrophosphate• Trisodium phosphate

P-H-O-S-phorus-containing Food Additives Common in Processed, Preserved, or Enhanced Foods and Soft Drinks

Motivational Interviewing: Steps for Success

• Engage the patient• Build rapport• Partner to set goals• Identify barriers to change• Support self-efficacy• Affirm successes

Martino S. Blood Purif. 2011;31:77-81.[13]