Patient awareness of phosphate-containing foods is essential in order to limit phosphate intake. Dairy products have two to three times more phosphate than equal quantities of protein derived from meat and therefore need to be limited. Milk intake should not exceed 1-3 pt/day and other dairy-containing foods such as chocolate, cheese and yoghurt should be restricted. Other highphosphate foods such as offal and offal-containing products, veal and fish with edible bones, such as sardines, pilchards and shell fish also need to be limited.
Phosphate binders reduce the absorption of dietary phosphate but when they are comprised solely of calcium salts they can result in hypercalcaemia leading to metastatic calcification. For this reason phosphate binders made from non-calcium salts, such as Sevelamer, may be preferred for the prevention of hyperphosphataemia. To be effective, phosphate binders containing calcium carbonate should be taken before meals as the ability of this salt to bind with phosphate is pH-dependent. The calcium in the phosphate binders may have the added advantage of helping patients achieve the necessary daily calcium requirements.
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