Individual preference may well play more substantial purpose in phosphorous management vs ‘healthy’ food items accessibility

Lisa Gutekunst, MSEd, RD, CSR, CDN, FNKF

A number of studies have located an inverse marriage involving socioeconomic position (SEC) and serum phosphorus (S.PO4). However, this is not the final result identified in a latest study by Potluri and colleagues.

In the “Effect of neighborhood food stuff natural environment and socioeconomic status on serum phosphorus degree for sufferers on persistent dialysis,” SEC and S. PO4 stages ended up evaluated on much more than 258,000 clients obtaining hemodialysis across the United States. No correlation between SEC and S. PO4 was found. Rather, scientists observed an inverse romance concerning age and S. PO4 levels.

Though effectively thought out and documented, the review strategies fall small in several locations which weakens the examine.

The key fault with this examine is the dedication of affected individual SEC. Alternatively of obtaining SEC aspects from individual members, scientists received SEC information and facts of the zip code in which sufferers lived. Community SEC has tiny bearing on an individual’s SEC. It is the particular person obtaining dialysis, not the neighborhood.

In comparison to this study, Gutiérrez and colleagues have also appeared at the romance concerning SEC and S. PO4 concentrations multiple time. In his experiments, unique SEC was established applying once-a-year revenue, schooling amount, work standing and poverty-to-income ratio. By performing this, he experienced a more true indication of SEC.

Next, researchers built numerous assumptions with regard to food procurement of the members. They assumed individuals shopped within their zip codes and they did not evaluate profiles of food shops in surrounding spots. They have no info about patients’ social life pertaining to foods procurement. Older people many have to have help with grocery procuring and have loved ones associates building meals options or they might be obtaining local community-sponsored meals (ie, Foods on Wheels, Mom’s Meals) that are adjusted for dialysis diet program constraints.

Additionally, scientists had no perception into what meals ended up ordered by clients. Just mainly because there are multiple “healthy” food stores for a patient to store, does not imply that the affected individual is picking out low phosphorus foodstuff. Suppliers considered “healthy” provide high phosphorus foodstuff.

To have an understanding of participants’ weight loss plans, Gutiérrez utilized several food items frequency questionnaires and 24-hour eating plan recalls giving him a fuller photo of the dietary PO4 sources.

Last but not least, only one S.PO4 level was received each and every month. Individuals might have numerous S. PO4 benefits in a solitary thirty day period, and the scientists did not point out which level was applied for investigation. This provides into issue the high-quality of the knowledge. 1 dialysis device may perhaps examination S. PO4 degrees after a month, bi-weekly or weekly. This will have to be regarded when standardizing facts collection. Also, S. PO4 is impacted by non-dietary variables which include metabolic acidosis, weak urea kinetic benefits and missed treatments.

Potluri and colleagues can be congratulated for taking on the initial investigation hunting at SEC and S. PO4 of hemodialysis clients. Nevertheless there are many faults with their procedures, their results identified the require to boost schooling and help younger clients regarding S. PO4 management.


Gutiérrez O, et. al. Decreased socioeconomic position related with bigger serum phosphate irrespective of race. J Am Soc. Nephrol. 21: 1953-1960. 2010.

Gutiérrez O, et. al. Influence of Poverty on Serum Phosphate Focus in the 3rd Countrywide Health and fitness and Diet Examination Study. J Ren Nutr. 21: 140-148. 2011.

Gutiérrez O, et. al. Associations of socioeconomic position and processed meals consumption with serum phosphorus concentrations in neighborhood-living grown ups: The multi-ethnic analyze of atherosclerosis (MESA). J Ren Nutr. 22: 480-489. 2012.

Lisa Gutekunst, MSEd, RD, CSR, CDN, FNKF

Renal Dietitian

DaVita Inc.

Disclosures: Gutekunst studies remaining an personnel of DaVita Inc. and a guide for Fresenius North The usa.&#13