Muhammad Bilal Khan,Mercedes R Carnethon,Tamara Isakova,Myles Wolf,Orlando M Gutiérrez
{"title":"降低膳食磷添加剂摄入量对有或无慢性肾病成人矿物质代谢的影响","authors":"Muhammad Bilal Khan,Mercedes R Carnethon,Tamara Isakova,Myles Wolf,Orlando M Gutiérrez","doi":"10.2215/cjn.0000000730","DOIUrl":null,"url":null,"abstract":"BACKGROUND\r\nExcess phosphorus additive intake leads to alterations in phosphorus metabolism that are linked to cardiovascular and kidney disease. The effects of lowering phosphorus additive intake in adults with and without chronic kidney disease (CKD) are unclear.\r\n\r\nMETHODS\r\nWe conducted a feeding study in 39 adults without and 11 adults with CKD. Participants were fed a phosphorus additive-enhanced diet for two weeks followed by a low additive diet for six weeks. Both diets were identical except for phosphorus additive content. Blood and urine samples were collected at regular intervals with analyses comparing follow-up measures of mineral metabolism markers to baseline values.\r\n\r\nRESULTS\r\nThe mean (SD) age of the non-CKD group was 34(12) years, among whom 51% were male, 36% were of Black race, and mean (SD) eGFR was 106(16) ml/min/1.73m2. The mean (SD) age of the CKD group was 72(6) years, among whom 36% were male, 82% were of Black race, and mean (SD) eGFR was 35(13) ml/min/1.73m2. After consuming the additive-enhanced diet for two weeks, consuming the low additive diet for six weeks decreased 24-hour urine phosphorus excretion by ∼30% in both groups. In the non-CKD group, the effect of the low additive diet on circulating fibroblast growth factor 23 (FGF23) concentrations differed by race (Pinteraction=0.03)-FGF23 decreased by 22% from baseline in White adults (P<0.001) but not in Black adults (P=0.08). In the CKD group, FGF23 decreased 25% after six weeks of the low additive diet (P<0.001) with no difference by race. Intact parathyroid hormone (PTH) concentrations decreased 20% in CKD participants and did not change in the non-CKD participants.\r\n\r\nCONCLUSION\r\nSix weeks of a low phosphorus additive diet decreased FGF23 and PTH in adults with moderate CKD. Lowering phosphorus additive intake lowered FGF23 in White adults without CKD but had no effect in Black adults without CKD.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"96 1","pages":""},"PeriodicalIF":8.5000,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effects of Lowering Dietary Phosphorus Additive Intake on Mineral Metabolism in Adults with and without Chronic Kidney Disease.\",\"authors\":\"Muhammad Bilal Khan,Mercedes R Carnethon,Tamara Isakova,Myles Wolf,Orlando M Gutiérrez\",\"doi\":\"10.2215/cjn.0000000730\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"BACKGROUND\\r\\nExcess phosphorus additive intake leads to alterations in phosphorus metabolism that are linked to cardiovascular and kidney disease. The effects of lowering phosphorus additive intake in adults with and without chronic kidney disease (CKD) are unclear.\\r\\n\\r\\nMETHODS\\r\\nWe conducted a feeding study in 39 adults without and 11 adults with CKD. Participants were fed a phosphorus additive-enhanced diet for two weeks followed by a low additive diet for six weeks. Both diets were identical except for phosphorus additive content. Blood and urine samples were collected at regular intervals with analyses comparing follow-up measures of mineral metabolism markers to baseline values.\\r\\n\\r\\nRESULTS\\r\\nThe mean (SD) age of the non-CKD group was 34(12) years, among whom 51% were male, 36% were of Black race, and mean (SD) eGFR was 106(16) ml/min/1.73m2. The mean (SD) age of the CKD group was 72(6) years, among whom 36% were male, 82% were of Black race, and mean (SD) eGFR was 35(13) ml/min/1.73m2. After consuming the additive-enhanced diet for two weeks, consuming the low additive diet for six weeks decreased 24-hour urine phosphorus excretion by ∼30% in both groups. In the non-CKD group, the effect of the low additive diet on circulating fibroblast growth factor 23 (FGF23) concentrations differed by race (Pinteraction=0.03)-FGF23 decreased by 22% from baseline in White adults (P<0.001) but not in Black adults (P=0.08). In the CKD group, FGF23 decreased 25% after six weeks of the low additive diet (P<0.001) with no difference by race. Intact parathyroid hormone (PTH) concentrations decreased 20% in CKD participants and did not change in the non-CKD participants.\\r\\n\\r\\nCONCLUSION\\r\\nSix weeks of a low phosphorus additive diet decreased FGF23 and PTH in adults with moderate CKD. Lowering phosphorus additive intake lowered FGF23 in White adults without CKD but had no effect in Black adults without CKD.\",\"PeriodicalId\":50681,\"journal\":{\"name\":\"Clinical Journal of the American Society of Nephrology\",\"volume\":\"96 1\",\"pages\":\"\"},\"PeriodicalIF\":8.5000,\"publicationDate\":\"2025-05-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Journal of the American Society of Nephrology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2215/cjn.0000000730\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Journal of the American Society of Nephrology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2215/cjn.0000000730","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
Effects of Lowering Dietary Phosphorus Additive Intake on Mineral Metabolism in Adults with and without Chronic Kidney Disease.
BACKGROUND
Excess phosphorus additive intake leads to alterations in phosphorus metabolism that are linked to cardiovascular and kidney disease. The effects of lowering phosphorus additive intake in adults with and without chronic kidney disease (CKD) are unclear.
METHODS
We conducted a feeding study in 39 adults without and 11 adults with CKD. Participants were fed a phosphorus additive-enhanced diet for two weeks followed by a low additive diet for six weeks. Both diets were identical except for phosphorus additive content. Blood and urine samples were collected at regular intervals with analyses comparing follow-up measures of mineral metabolism markers to baseline values.
RESULTS
The mean (SD) age of the non-CKD group was 34(12) years, among whom 51% were male, 36% were of Black race, and mean (SD) eGFR was 106(16) ml/min/1.73m2. The mean (SD) age of the CKD group was 72(6) years, among whom 36% were male, 82% were of Black race, and mean (SD) eGFR was 35(13) ml/min/1.73m2. After consuming the additive-enhanced diet for two weeks, consuming the low additive diet for six weeks decreased 24-hour urine phosphorus excretion by ∼30% in both groups. In the non-CKD group, the effect of the low additive diet on circulating fibroblast growth factor 23 (FGF23) concentrations differed by race (Pinteraction=0.03)-FGF23 decreased by 22% from baseline in White adults (P<0.001) but not in Black adults (P=0.08). In the CKD group, FGF23 decreased 25% after six weeks of the low additive diet (P<0.001) with no difference by race. Intact parathyroid hormone (PTH) concentrations decreased 20% in CKD participants and did not change in the non-CKD participants.
CONCLUSION
Six weeks of a low phosphorus additive diet decreased FGF23 and PTH in adults with moderate CKD. Lowering phosphorus additive intake lowered FGF23 in White adults without CKD but had no effect in Black adults without CKD.
期刊介绍:
The Clinical Journal of the American Society of Nephrology strives to establish itself as the foremost authority in communicating and influencing advances in clinical nephrology by (1) swiftly and effectively disseminating pivotal developments in clinical and translational research in nephrology, encompassing innovations in research methods and care delivery; (2) providing context for these advances in relation to future research directions and patient care; and (3) becoming a key voice on issues with potential implications for the clinical practice of nephrology, particularly within the United States. Original manuscript topics cover a range of areas, including Acid/Base and Electrolyte Disorders, Acute Kidney Injury and ICU Nephrology, Chronic Kidney Disease, Clinical Nephrology, Cystic Kidney Disease, Diabetes and the Kidney, Genetics, Geriatric and Palliative Nephrology, Glomerular and Tubulointerstitial Diseases, Hypertension, Maintenance Dialysis, Mineral Metabolism, Nephrolithiasis, and Transplantation.