The impact of a nutritional intervention based on egg white for phosphorus control in hemodialyis patients

• Published in: Nutrition, metabolism, and cardiovascular diseases Vol. 29; no. 1; pp. 45 - 50
• Main Authors: Guida, B., Parolisi, S., Coco, M., Ruoppo, T., Veccia, R., di Maro, M., Trio, R., Memoli, A., Cataldi, M.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.01.2019
• Subjects: Adult; Body Composition; Dietary treatment; Egg Proteins, Dietary - administration & dosage; Egg Proteins, Dietary - adverse effects; Egg white; Female; Hemodialysis; Humans; Hyperphosphatemia; Hyperphosphatemia - blood; Hyperphosphatemia - diagnosis; Hyperphosphatemia - diet therapy; Hyperphosphatemia - etiology; Italy; Male; Meat - adverse effects; Middle Aged; Phosphorus, Dietary - adverse effects; Phosphorus, Dietary - blood; Protein energy wasting; Protein-Energy Malnutrition - etiology; Protein-Energy Malnutrition - prevention & control; Renal Dialysis - adverse effects; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - therapy; Seafood - adverse effects; Time Factors; Treatment Outcome; Italy; Hyperphosphatemia; Dietary treatment; Egg white; Hemodialysis; Protein energy wasting
• ISSN: 0939-4753; 1590-3729
• DOI: 10.1016/j.numecd.2018.09.010

Here we describe a dietary intervention for hyperphosphatemia in dialysis patients based on the partial replacement of meat and fish, which are one of the main sources of alimentary phosphorous, with egg white, a virtually phosphorous-free protein source. This intervention aims to reduce phosphorous intake without causing protein wasting. As many as 23 hyperphosphatemic patients (15 male and 8 female, mean age 53.0 ± 10.0 years) on chronic standard 4 h, three times weekly, bicarbonate hemodialysis were enrolled in this open-label, randomized controlled trial. Patients in the intervention group were instructed to replace fish or meat with egg white in three meals a week for three months whereas diet was unchanged in the control group. Serum phosphate concentrations were significantly lower in the intervention group than in controls after three (4.9 ± 1.0 vs 6.6 ± 0.8; p < 0.001) but not after one month of treatment. Phosphate concentrations decreased more from baseline in the intervention than in the control group both after one (−1,2 ± 1,1 vs 0,5 ± 1,1; p = 0.004) and after three (−1,7 ± 1,1 vs −0,6 ± 1,1; p < 0.001) months of follow-up. No change either in body weight or in body composition assessed with bioelectrical impedance analysis or in serum albumin concentration was observed in either group. The partial replacement of meat and fish with egg white induces a significant decrease in serum phosphate without causing protein malnutrition and could represent a useful instrument to control serum phosphate levels in hemodialysis patients. NCT03236701. •An egg white containing diet normalized phosphatemia in hemodialysis patients.•Patients were highly adherent to this nutritional intervention.•This diet did not negatively affect body composition or serum albumin.