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To the Editor: The clinical trial by Dr Sullivan and colleagues¹ showed that the serum phosphorus concentration can be reduced in patients on maintenance hemodialysis by avoiding phosphorus-containing food additives. The results are potentially useful to guide educational interventions aimed at improving the nutritional care of hemodialysis patients. The findings also have public health importance, considering that high serum phosphorus concentration is a risk factor for adverse cardiovascular events and bone disease among patients at earlier stages of chronic kidney disease.²

However, to translate the results into clinical practice recommendations for the care of patients on maintenance hemodialysis it is necessary to take into account limitations of the study, particularly regarding the absence of information about the effect of the intervention on protein intake. Lack of appetite is very common among hemodialysis patients.³ Phosphorus-containing additives are often added to enhance the flavor of processed foods, which may contribute to food . . . [Full Text of this Article]

Antonio Alberto Lopes, MD, MPH, PhD
aaslopes@ufba.br
Departamento de Medicina
Faculdade de Medicina

Gildete Barreto Lopes, MS, RN
Núcleo de Epidemiologia Clínica
Hospital Universitário Professor Edgard Santos
Universidade Federal da Bahia
Salvador, Brazil

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Effect of Food Additives on Hyperphosphatemia Among Patients With End-stage Renal Disease: A Randomized Controlled Trial
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Reducing Serum Phosphorus Concentration in Patients With End-Stage Renal Disease—Reply
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