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, 8 (11), e78660
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Inadequate Awareness Among Chronic Kidney Disease Patients Regarding Food and Drinks Containing Artificially Added Phosphate

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Inadequate Awareness Among Chronic Kidney Disease Patients Regarding Food and Drinks Containing Artificially Added Phosphate

Yoshiko Shutto et al. PLoS One.

Abstract

Hyperphosphatemia is an important determinant of morbidity and mortality in patients with chronic kidney disease (CKD). Patients with CKD are advised to consume a low phosphate diet and are often prescribed phosphate-lowering drug therapy. However, commercially processed food and drinks often contain phosphate compounds, but the phosphate level is not usually provided in the ingredient list, which makes it difficult for CKD patients to choose a correct diet. We conducted a survey of the awareness of food/beverages containing artificially added phosphate among CKD patients undergoing hemodialysis. The subjects were 153 patients (77 males and 76 females; average age 56±11 years) who were randomly selected from the Dialysis Center of Hirosaki City, Japan. The subjects were provided with a list of questions. The survey results showed that 93% of the subjects were aware of the presence of high sugar content in soda, whereas only 25% were aware of the presence of phosphate (phosphoric acid) in such drinks. Despite 78% of the subjects being aware of the detrimental effects of consumption of a high phosphate diet, 43% drank at least 1 to 5 cans of soda per week and about 17% consumed "fast food" once each week. We also assessed the immediate effects of high-phosphate containing carbonated soda consumption by determining urinary calcium, phosphate, protein and sugar contents in overnight fasted healthy volunteers (n = 55; average age 20.7±0.3 years old, 20 males and 35 females). Significantly higher urinary calcium (adjusted using urinary creatinine) excretion was found 2 h after consuming 350 ml of carbonated soda compared to the fasting baseline level (0.15±0.01 vs. 0.09±0.01, p = 0.001). Our survey results suggest that CKD patients undergoing hemodialysis are not adequately aware of the hidden source of phosphate in their diet, and emphasize the need for educational initiatives to raise awareness of this issue among CKD patients.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. The survey participant CKD patients were asked whether they were aware of the sugar and phosphate content in commercially available soda drinks.
Almost 93% of the participants were aware of the presence of sugar, while only 25% were aware of the presence of phosphate (phosphoric acid) in such drink, showing a noticeable awareness gap related to phosphate-contenting drinks among the patients.
Figure 2
Figure 2. The participants were asked to describe their soda drink and fast food consumption habits.
Almost half (51%) of the CKD patients drink soda, while 39% patients eat fast food.
Figure 3
Figure 3. The survey participant CKD patients were asked whether they were aware of the possible harmful effects of unrestricted consumption of a high phosphate diet, and the majority (78%) of the participants was aware of detrimental effects related to high phosphate diet.
Figure 4
Figure 4. The survey participant CKD patients were asked whether they were willing to modify their diet to reduce phosphate intake.
Around 35% of the participants wanted to have more information related to artificially containing-food and drinks, and another 45% were willing to reduce their phosphate intake by minimizing consumption of processed food and soda drinks.

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Grant support

This work was supported by the National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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