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Academy's Commentary on the KDOQI Guideline's Phosphorus Recommendation

Published February 2, 2024

Published by the Academy of Nutrition and Dietetics and the National Kidney Foundation, the Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guideline for Nutrition in CKD: 2020 Update recommends adjusting dietary phosphorus for hemodialysis patients to maintain a serum phosphate goal in the normal range (2.5 to 4.5 mg/dL). This is lower than the serum phosphate goal currently used by many dialysis centers (3.0 and 5.5 mg/dL). 

Although context and clinical judgement must always be considered when providing individualized care to patients, a recent CKD guideline implementation study found that registered dietitian nutritionists from two national dialysis chains were almost universally using dialysis center serum phosphate goals instead of the goal recommended by the updated KDOQI guideline.

The cause for this divergence occurs at various levels (individual, organizational/institutional, governmental) and therefore requires a systems level solution. A call to action must include various changes such as RDN training, dialysis centers alignment with guidelines, and policy regulations advocating for phosphorus label disclosures to help patients make informed decisions. The CKD study was funded by the Academy Foundation through a grant from the Academy’s Renal Dietitians Dietetic Practice Group and Relypsa, Inc.

Read the commentary regarding the discrepancy published in the Journal of Renal Nutrition.

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