Impact of Personalized Dietary Counseling and Nutritional Interventions on the Control of Hyperphosphatemia in Hemodialysis Patients. A mini review

Abstract

Background: Hyperphosphatemia is common in hemodialysis patients due to reduced kidney function and is linked to higher mortality and complications like cardiovascular disease. Controlling serum phosphorus is difficult because of hidden phosphate additives in processed foods and poor treatment adherence. Ultra processed foods, especially animal-based, independently increase hyperphosphatemia risk, highlighting the need for dietary focus on natural foods. Personalized nutritional counseling and multidisciplinary care improve phosphate control and patient outcomes. Aim and objects: 1- To assess the effectiveness of tailored dietary counseling and interventions in reducing serum phosphorus levels among hemodialysis patients with Hyperphosphatemia. 2- To evaluation the level of dietary knowledge among hemodialysis patients diagnosed with Hyperphosphatemia. Methods and Materials: Studies on Hyperphosphatemia in hemodialysis patients were identified through systematic searches of major scientific databases, including PubMed, Google Scholar, Research Square, and Science Direct, supplemented by KDIGO 2024 Clinical Practice Guidelines, covering the period from 2020 to 2025. These studies encompass randomized controlled trials, phase 2 and 3 clinical trials, and cross-sectional analyses conducted internationally in countries such as Iraq, China, Qatar, Romania, and the United States. The selection focused on adult patients with stage 5 chronic kidney disease undergoing maintenance hemodialysis with elevated serum phosphate levels, Investigated interventions include novel phosphate binders (e.g., tenapanor and ASP3325) alongside intensive, individualized nutritional counseling and multidisciplinary education programs. Evidence was gathered from peer-reviewed journals specializing in nephrology and renal nutrition, providing an in-depth review of current therapeutic strategies and risk factors. Conclusion: Effective management of hyperphosphatemia in hemodialysis patients requires personalized nutritional strategies supported by intensive multidisciplinary education rather than strict dietary restrictions. Addressing hidden phosphate additives in ultra processed foods and medications is crucial. Pharmacologic agents like tenapanor and AP306 effectively reduce serum phosphate but may cause gastrointestinal side effects. Combining personalized diet, education, pharmacologic therapy, and community support optimizes phosphate control and patient outcomes.