Phosphate content of beverages in addition to food phosphate additives: real and insidious danger for renal patients.
The association of high plasma phosphate levels with cardiovascular morbidity and mortality is increasingly recognized. This association has been most clearly demonstrated particularly in patients with renal disease, both in patients under chronic dialysis and in those under conservative treatment in which elevated serum phosphorus level has been shown to relate with disease progression. This association has also been extended to include healthy individuals in whom blood phosphate levels in the high normal range were shown to be associated with an increased coronary artery calcium content, this latter being strongly associated with atherosclerosis and cardiovascular disease risk. Given the relationship between dietary phosphate intake and plasma phosphate, and considering the importance of reduced phosphate intake—particularly to control the phosphate levels in dialysis patients—phosphate intake, sources, and means of reducing plasma phosphate are of primary importance and the subject of considerable research. The study of Benini et al., published in the July issue of the Journal of Renal Nutrition, which we read with great interest, reporting on the contribution of the ‘‘hidden’’ phosphate in the food, essentially that used as food additive, to the worsening of phosphate balance control in patients with renal disease, adds another important evidence to the crucial issue of identifying the