Helical noncontrast-enhanced CT showing calcification involving the left main coronary artery.

Helical noncontrast-enhanced CT showing calcification involving the left main coronary artery.

Example of Coronary CalcificationExample of Coronary Calcification

Age, yDietary Calcium

Limit, mg/d19-30 2500

31-50 2500

51-70 2000

> 70 2000

IOM website.[1]

Upper Level Calcium Intake: AdultsUpper 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 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) 100

Peanuts (2 oz) 200 Popcorn (1.5 c) 35

Hard cheese (1 oz) 145 Cream cheese (1 oz) 30

Oatmeal (2/3 c) 130 Cream of wheat or grits (2/3 c)

40

Pinto beans (1/2 c) 100 Green beans (1/2 c) 35

Ice cream (1/2 c) 80 Sherbet (1/2 c) 0

Egg (1 large) 72 Egg white (1 large) 5

Dark cola (12 oz) 55 Ginger ale (12 oz) 3

Phosphate Binder Available FormsAluminum hydroxide* Liquid, capsule, tablet

Calcium acetate† Capsule, tablet

Calcium carbonate† Liquid, tablet, capsule, chewable, gum

Lanthanum carbonate Wafer, chewable

Sevelamer hydrochloride Tablet

Sevelamer carbonate Tablet, powder

Sucroferric 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

Phosphate Binders Commonly Used to Manage Hyperphosphatemia in Patients With CKD

Patient Education ResourcesPatient 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 ChoicesMaking 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

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

Motivational Interviewing: Steps for SuccessMotivational 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]