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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