Hyperphosphatemia in patients on hemodialysis may be driven by the consumption of ultraprocessed foods.

Abstract

Objective: We aimed to investigate the role of dietary diversity of unprocessed and minimally processed foods and the intake of ultraprocessed foods (UPFs), along with their respective phosphorus source subgroups, in hyperphosphatemia among patients on chronic hemodialysis (HD).

Methods: This is a secondary analysis of a multicenter cross-sectional study conducted in seven dialysis units in Southern Brazil. Two validated questionnaires were used: a dietary diversity questionnaire to assess the intake of unprocessed and minimally processed foods, and a UPFs consumption questionnaire to evaluate the intake of UPFs. Dietary intake was assessed on two separate days-one dialysis day and one non-dialysis day. From these instruments, scores were calculated for overall dietary diversity, total UPFs consumption, and phosphorus sources subgroups.

Results: A total of 297 patients participated (age: 52.1±14.1 years; 57.9% men; 42% with hyperphosphatemia). While unprocessed and minimally processed phosphorus sources were more commonly consumed, multivariate analysis revealed that UPFs, particularly those from animal-based sources, were independently associated with hyperphosphatemia. Each one-point increase in intake of UPFs scores corresponded to an increased likelihood of hyperphosphatemia: 25% for total UPF, 76% for animal-based UPFs, and 24% for other UPFs sources.

Conclusion: Our findings indicate that although phosphorus sources from UPFs were consumed less frequently than those from unprocessed and minimally processed foods, consumption of UPFs - especially those from animal-based sources - was an independent determinant of hyperphosphatemia. These results highlight the need for dietary interventions that prioritize healthy food choices in the management of hyperphosphatemia.