【Abstract】Objective To study the efficacy and safety of low protein rice plus low phosphorus whey on hyperphosphatemia in hemodialysis patients. Methods The hemodialysis patients who had average serum phosphorus of ≥1.78 mmol/L for three consecutive months were enrolled in this self-controlled trial. Patients received low phosphorus diet instruction for 4 weeks as baseline, followed by change of the staple foods to the same amount of low protein rice for 10 weeks. The difference of protein intake between the low protein rice and staple foods was replaced by low phosphorus whey. Then the patients reverted to staple foods for 8 weeks. Serum phosphorus, calcium, intact parathyroid hormone (iPTH), serum albumin and nutritional status before and after dietary changes were observed and analyzed. Throughout the trial, dialysis treatment remained unchanged; appropriate adjustment of oral phosphorous binding agent, active vitamin D or calcimimetic treatment based on the results of calcium, phosphorus and iPTH were allowed. The changes of these medications were recorded and analyzed. Results A total of 29 patients completed the study. Serum phosphorus at the beginning was 2.15±0.28 mmol/L. After 4 weeks of low phosphorus diet instruction, serum phosphorus decreased but without statistical significance. After 2 weeks of low protein rice plus low phosphate whey, there were no significant differences in calorie and protein intake, while phosphorus intake was significantly reduced (t=5.132, t=- 2.200, P＜0.001, P=0.037, respectively); serum phosphorus reduced to 1.82 ± 0.45mmol/L, which was significantly lower than the baseline value (t=-2.200, P=0.037). This effect continued until the end of 10 weeks (t=-2.011, P=0.048, compared to baseline value). After reverted to staple foods for 8 weeks in which calorie and protein intake had no significant differences, phosphorus intake increased significantly (t=-2.577, P=0.016); serum phosphorus increased significantly compared to that during food intervention at 10th week (t=2.979, P=0.006) and had no significant difference from baseline value. In addition, serum albumin increased significantly (t=5.376, P＜0.001). There were no changes in serum calcium and iPTH levels, dialysis regimen and phosphorus-binding agents throughout the study. Conclusion For hemodialysis patients, low protein rice plus low phosphorus whey can effectively reduce phosphorus intake, decrease serum phosphorus level, and improve serum albumin on the basis of enough calorie and protein intake.
