Asupan protein dan fosfor, rasio fosfor-protein, dan kadar fosfor darah pada pasien gagal ginjal kronis dengan hemodialisis

https://doi.org/10.22146/ijcn.15380

Ahmad Syauqy(1*), Susetyowati .(2), Suhardi .(3)

(1) Program Studi Ilmu Gizi, Fakultas Kedokteran Universitas Diponegoro
(2) Program Studi Gizi Kesehatan, Fakultas Kedokteran Universitas Gadjah Mada
(3) Instalasi Hemodialisis Rumah Sakit Umum Pusat Dr. Sardjito
(*) Corresponding Author

Abstract


Background: Hyperphosphatemia has become one of the main causes of death in CKD patients on HD. Thus, correction and prevention of hyperphospatemia is a major component in the management of HD patients. High protein diet in HD patients may lead to increased serum phosphate level due to mineral metabolism disorder associated with decreased glomerular filtration rate. In addition, high protein intake often followed by high phosphate intake as high protein foods also contains high phosphate and may cause hyperphosphatemia. Meanwhile, reduction of protein intake to control phosphate level was associated with decreased health and nutritional status in CKD patients. Therefore, appropriate phosphate-protein ratio is essential to provide adequate protein intake and avoid hyperphosphatemia.

Objective: To investigate the association between protein and phosphate intake, phosphate-protein ratio and blood phosphate level in CKD patients on routine HD.

Method: The study used an analytic observational method with cross sectional design. There were 100 subjects involved in this study. Subject characteristics, protein and phosphate intake, phosphate-protein ratio and intake of phosphate binders were obtained through interview and 3 x24 hour food record. Serum phosphate level was analyzed by inorganic phosphorus quantification method. Food processor was used to analyze the intake of protein and phosphate. Bivariate and multivariate tests with 95% confidence interval were used to analyze the data.

Results: Adequate protein intake was observed among 38% subjects, while 46% of them have excess phosphate intake.High phosphate-protein ratio was found in 20% subjects. Most subjects did not take phosphate binders regularly (61%) and have hyperphosphatemia (66%). The average protein intake, phosphate intake, phosphate-protein ratio, and blood phosphate level were 1.1 g/kg/d, 13.5 mg/kg/d, 12.8 mg/g, and 5.6 mg/dl, respectively. Bivariate test showed that there was a significant association between protein intake (p=0.037; RP=2.78), phosphate intake (p=0.005; RP=3.54), phosphate-protein ratio (p=0.045; RP=3.85), and blood phosphate level in CKD patients on routine HD. Multivariate analysis revealed that high phosphate intake and did not consume phosphate binders regularly  were risk factors of hyperphosphatemia (p=0.000; OR=6.543; CI 95%:2.357-18.164 dan p=0.024; OR=3.413; CI 95%:1.179; R2=0.42).

Conclusion: Consumtion of low phosphate foods and phosphate binders may reduce the risk of hyperphosphatemia in CKD patients on routine HD.


Keywords


hyperphosphatemia; protein intake; phosphate intake; phosphate-protein ratio; chronic renal failure; hemodialysis

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References

Renal Data System. USRDS 2003 annual data report: atlas of end-stage renal disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2003.

Schiffrin EL, Lipman ML, Mann JF. Chronic kidney disease: effects on the cardiovascular system. Circulation 2007;116(1):85-97.

Cases Amenos A, Gonzalez-Juanatey JR, Conthe Gutierrez P, Matali Gilarranz A, Garrido Costa C. Prevalence of chronic kidney disease in patients with or at a high risk of cardiovascular disease. Rev Esp Cardiol 2010;63(2):225-8.

Noori N, Kalantar-Zadeh K, Kovesdy CP, Bross R, Benner D, Kopple JD. Association of dietary phosphorus intake and phosphorus to protein ratio with mortality in hemodialysis patients. Clin J Am Soc Nephrol 2010;5(4):683-92.

Achinger SG, Ayus JC. Left ventricular hypertrophy: is hyperphosphatemia among dialysis patients a risk factor?. J Am Soc Nephrol 2006;17(12 Suppl 3):S255-61.

Shinaberger CS, Greenland S, Kopple JD, Wyck DV, Mehrotra R, Kovesdy CP, Kalantar-Zadeh K. Is controlling phosphorus by decreasing dietary protein intake beneficial or harmful in persons with chronic kidney disease. Am J Clin Nutr 2008;88(6):1511-8.

Cupisti A, D’Alessandro C, Baldi R, Barsotti G. Dietary habits and counseling focused on phosphate intake in hemodialysis patients with hyperphosphatemia. J Ren Nutr 2004;14(4):220-5.

Kalantar-Zadeh K, Gutekunst L, Mehrotra R, Kovesdy CP, Bross R, Shinaberger CS, Noori N, Hirschberg R, Benner D, Nissenson AR, Kopple JD. Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease. Clin J Am Soc Nephrol 2010;5(3):519-30.

National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003;42(4 Suppl 3):S1-201.

Suwitra K. Pola kadar fosfat, kalsium dan hormon paratiroid pada penyakit ginjal terminal dengan HD regular di RSUP Sanglah Denpasar. Acta Medica Indonesiana 2000;XXXII(4):167-70.

Gallieini M, Cucciniello E, D’Amaro E, Fatuzzo P, Gaggiotti A, Maringhini S, Rotolo U, Brancaccio D; CARDIALISI Study Group. Calcium, phosphate and PTH levels in hemodialysis population: a multicenter study. J Nephrol 2002;15(2):165-70.

Chiu YW, Teitelbaum I, Misra M, de Leon EM, Adzize T, Mehrotra R. Pill burden, adherence, hyperphosphatemia, and quality of life in maintenance dialysis patients. Clin J Am Soc Nephrol 2009;4(6):1089-96.

Rees L, Shroff RC. Phosphate binders in CKD: chalking out the differences. Pediatr Nephrol 2010;25(3):385-94.



DOI: https://doi.org/10.22146/ijcn.15380

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