マンセイ ジンゾウビョウ ニオケル リン タイシャ イジョウ ト ショクジ カンリ

Chronic kidney disease is a common disease impacting more than １３ million individuals in Japan. CKD causes various complications including cardiovascular disease, infectious disease, and metabolic bone disease. Systemic mineral disorder caused by CKD increases cardiovascular disease and mortality risks as well as metabolic bone disease. Now, it is known as CKD-mineral and bone disease（CKD-MBD）characterized by blood biochemical abnormalities, bone abnormalities and extraskeletal calcification. Management of CKD-MBD is important to decrease cardiovascular disease and mortality risks. Hyperphosphatemia is a primary cause of CKD-MBD. Not only correction of hyperphosphatemia but also decrease in dietary phosphorus load is a key strategy for management of CKD-MBD. Here we will provide an overview of disorder of phosphorus metabolism and dietary management in CKD patients

PHOSPHATEMIC INDEX EVALUATES PHOSPHORUS LOAD

Objective: Dietary phosphorus (P) restriction is crucial to treat hyperphosphatemia and reduce cardiovascular disease risk and mortality in patients with chronic kidney disease (CKD) and the wider population. Various methods for dietary P restriction exist, but the bioavailability of P in food should also be considered when making appropriate food choices to maintain patients’ quality of life. Here, we propose the ‘‘Phosphatemic Index’’ (PI) as a novel tool for evaluating dietary P load based on P bioavailability; we also evaluated the effect of continuous intake of different PI foods in mixed meals on serum intact fibroblast growth factor 23 concentration. Design and Methods: A 2-stage crossover study was conducted: Study 1: 20 healthy participants consumed 10 different foods containing 200 mg of P, and the PI was calculated from the area under the curve of a time versus serum P concentration curve; Study 2: 10 healthy participants consumed 4 different test meals (low, medium, or high PI meals or a control) over a 5-day period. Results: Study 1 showed milk and dairy products had high PI values, pork and ham had medium PI values, and soy and tofu had low PI values. In Study 2, ingestion of high PI test meals showed higher fasting serum intact fibroblast growth factor 23 levels and lower serum 1,25-dihydroxyvitamin D levels compared with ingestion of low PI test meals. Conclusion: These findings suggest that the PI can usefully evaluate the dietary P load of various foods and may help to make appropriate food choices for dietary P restriction in CKD patients