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In Reply: As Dr Lopes and Ms Lopes point out, restricting dietary phosphorus intake may be associated with unacceptable declines in protein intake. This may occur because many foods that are naturally high in phosphorus, such as meats, dairy products, beans, and nuts, are also important protein sources. However, the widespread use of phosphorus-containing food additives, especially in low-protein products such as baked goods and beverages, has weakened the link between phosphorus and protein intake. Therefore, avoiding baked goods and beverages that contain phosphorus additives should have little effect on protein intake.

Moreover, we instructed our intervention participants to select protein foods that did not contain phosphorus additives at grocery stores and fast food restaurants. We did not measure protein nitrogen appearance as part of our clinical trial. However, there were no differences between intervention and control patients at the beginning or the end of the trial in postdialysis weight, . . . [Full Text of this Article]

Ashwini R. Sehgal, MD
sehgal@case.edu

Catherine Sullivan, MS, RD, LD; Srilekha S. Sayre, MS, RD, LD
Division of Nephrology
MetroHealth Medical Center
Cleveland, Ohio

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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
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