Food Costs Can Lead To Less Protein and Phosphorous in Indigent Kidney Transplant Patients Interview with:

Ms. Shifra Mincer Medical Student in the class of 2019 SUNY Downstate Medical School

Shifra Mincer

Ms. Shifra Mincer
Medical Student in the class of 2019
SUNY Downstate Medical School What is the background for this study? What are the main findings?

Response: Hypophosphatemia is commonly encountered in the post-transplant setting. Early post-transplant hypophosphatemia has been ascribed to excess FGF23 and hyperphosphaturia.

Many patients remain hypohosphatemic months or even years after their transplant and the mechanism was assumed to be the same, however, our group recently reported that patients with late post-transplant hypophosphatemia had very little phosphorous in their urine (Wu S, Brar A, Markell, MS. Am J Kidney Dis. 2016,67(5): A18). We hypothesized that they were not eating enough phosphorous to compensate for the acute phosphorous losses they experienced immediately post-transplant.

In this study, using both 3-day diet journals and 24-hour diet recall questionnaires, we found that mean intake of phosphorous and protein was barely at the Recommended Daily Allowance, and that despite 70% of the patients using EBT, 30% of those patients still reported concerns regarding food security. Patients who reported that the cost of food influenced their dietary choices ate 43% less protein (average 48,5 gms vs. 85.8 gms) and 29% less phosphorous (average 887 mg vs 1257 mg). When ability to rise from a chair over a 30 second period was evaluated, only patients who expressed food cost concerns were unable to complete the test. What should readers take away from your report?

Response: Our patient population is predominantly indigent, with a mean income of <$20,000 yearly. Even though the majority of patients studied qualify for EBT support, only those individuals who reported that cost of food influenced their food choices presented with objective measures of frailty. This finding highlights both the importance of dietary intake of phosphorous as a contributor to hypophosphatemia in the post transplant population but also suggests that lower protein and phosphorous intake may influence physical strength. It also suggests that nutrition education should be provided throughout the life of the kidney transplant, especially for patients who express concern over possible inability to pay for food. What recommendations do you have for future research as a result of this study?

Response: Future studies should include further examination of the factors that influence food choices in our population, which is ethnically diverse, as well as indigent. In addition, an examination of the impact of lack of local availability of affordable healthy food choices as well as an intervention study, examining the effects of nutrition education on diet and phosphate levels should be performed.

No disclosures Thank you for your contribution to the community.


NKF Spring Clinical Meetings 2017 Abstract

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Last Updated on April 27, 2017 by Marie Benz MD FAAD