LAUSR

To investigate the effect of changing dietary phosphorus-protein ratio on the nutritional status of maintenance hemodialysis patients. Hemodialysis patients who had average serum phosphorus ≥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 changed the diet of staple foods with 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 food for 8 weeks. Serum phosphorus, albumin and nutritional status before and after dietary changes were observed and analyzed. 29 patients completed the study. At baseline dietary phosphorus-protein ratio was (15.85±3.29) mg/g, and serum phosphorus was (2.05±0.32) mmol/L. After switch to low protein rice and low phosphorus whey for 10 weeks, dietary phosphorus-protein ratio decreased to (12.18±2.45) mg/g (p<0.001). Simultaneously serum phosphorus decreased to (1.87±0.44) mmol/L (p=0.048). Nutritional status evaluation showed the patients’ serum albumin increased significantly compared with baseline (42.29±3.51 vs. 39.84±3.23 g/L, p<0.001), as well as dry body weight (65.09±15.30 vs. 64.71 ± 15.07 kg, p=0.030), upper arm muscle circumference (22.57±2.83 vs 22.00±3.03 cm, p=0.013), and the grip strength (27.89±7.82 vs. 26.54±7.90 kg, p=0.032). Subjective global assessment (SGA) and serum lipid level did not change significantly after the food change. For hemodialysis patients, changing dietary phosphorus-protein ratio by combination of low protein rice and low phosphorus whey could effectively decrease serum phosphorus level, and improve serum albumin, as well as muscle mass and muscle strength.