POS-286 ASSESSMENT OF PHOPSHATE INTAKE AND IMPLEMENTATION OF PARENTAL STRUCTURED DIETARY PHOSPHATE EDUCATION IN PEDIATRIC CKD-A PROSPECTIVE STUDY

Abstract

Hyperphosphatemia is an important co morbidity of chronic kidney disease (CKD) with long term implications on cardiovascular health. The KDOQI 2008 guidelines based on dietary references intakes (DRI) and PRNT [Pediatric Renal Nutrition task force] 2020 guidelines based on suggested daily intakes (SDI) provide recommendations for phosphorus(P) intake in children with CKD. Besides, differences in food culture demands detailed assessment of dietary intake of phosphorus and its sources in children across regions. Data on dietary phosphorus intake and sources in Indian children with CKD has not been systematically studied. The aim of this study was to evaluate for dietary intake and sources of phosphorus with reference to KDOQI and PRNT guidelines and assess the impact of parental structured phosphate education in the management of hyperphosphatemia. This prospective study included children aged 2-18yrs with stage2-5DCKD[calculated sample size 58] recruited from April 2018 to November 2019. Phosphorus intake was assessed by 24 hour dietary recall, analysed using food processor software (version7.4,1999, ESHA,Portland,OR,USA) and interpreted based on KDOQI 2008 and PRNT recommendations. No change in phosphate binders were made during the study period. Parents of those with hyperphosphatemia were subjected to a structured phosphate education comprising of pamphlets in regional languages describing the importance of dietary phosphorus control. A phosphorus pyramid based on Indian foods and phosphorus lowering techniques was formulated (Figure 1) for the parental education. Serum phosphate was monitored once in 2 months for 6 months. Figure 2 depicts the study flow. Seventy of the 75 children screened were recruited [mean age 9.4±3.4 years, CKD2-4:49% (n=34), CKD5/5D:51% (n=36), 27/36 on peritoneal dialysis, 20% vegetarians] with median duration of CKD being 3.8 [IQR2,6] years. The mean daily phosphorus intake was comparable between children with and without hyperphosphatemia [908±279 mg vs 814±302 mg, p=0.1]. Dairy and bakery products were main dietary sources of phosphorus. Based on DRI of KDOQI and SDI of PRNT recommendations, high phosphorus intake was observed in 51%and 64% of the cohort and in 58% and 100% of those with hyperphosphatemia respectively. Hyperphosphatemia was observed in 51% (Stage 2 to 4 CKD:33%; CKD5:67%; CKD5D:55% p=0.6). In 36 parents who received phosphate education, 29 children completed 6 months follow up and serum phosphate levels reduced to normal in 66%. Reduction in serum phosphate was independent of age, stage of CKD, dietary intake of phosphorus or intake of phosphate binders. In children with CKD2-5D,dietary intake of phosphorus is comparable in those with and without hyperphosphatemia. DRI based KDOQI2008 recommendation underestimated dietary phosphate intake compared to SDI based PRNT recommendations. In the majority, parental structured phosphate education using the phosphorus pyramid, is useful in the management of hyperphosphatemia.