A Systematic Review of Online Resources for the Dietary Management of Hyperphosphatemia in People With Chronic Kidney Disease

Most Murshida Begum; Annabel Biruete; Brandon Kistler; Anthony Meade; John Westhoff; David E St-Jules

doi:10.1053/j.jrn.2024.01.005

A Systematic Review of Online Resources for the Dietary Management of Hyperphosphatemia in People With Chronic Kidney Disease

J Ren Nutr. 2024 Mar 13:S1051-2276(24)00033-5. doi: 10.1053/j.jrn.2024.01.005. Online ahead of print.

Authors

Most Murshida Begum¹, Annabel Biruete², Brandon Kistler², Anthony Meade³, John Westhoff⁴, David E St-Jules⁵

Affiliations

¹ Department of Nutrition, University of Nevada, Reno, Nevada.
² Department of Nutrition Science, Purdue University, West Lafayette, Indiana.
³ Central Northern Adelaide Renal and Transplantation Service Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
⁴ Department of Internal Medicine, School of Medicine, University of Nevada, Reno, Nevada.
⁵ Department of Nutrition, University of Nevada, Reno, Nevada. Electronic address: stjules@unr.edu.

PMID: 38485068
DOI: 10.1053/j.jrn.2024.01.005

Abstract

Objective: Internet search engines and social media websites are prominent and growing sources of dietary information for people with chronic kidney disease (CKD) and their healthcare providers. However, nutrition therapy for CKD is undergoing a paradigm shift, which may lead to inconsistent advice for managing hyperphosphatemia. The aim of this study was to summarize and evaluate online resources for phosphorus-specific nutrition therapy.

Design and methods: Patient-facing resources were collected from Google, Yahoo, and Facebook in June-July 2021. Using nine independent search terms, the first 100 hits were reviewed. Dietary advice for food types, food groups, food subgroups, and individual food items was categorized as "restricted," "recommended," "mixed," and "not mentioned." Information on publication date, source, and author(s), phosphorus bioavailability, and demineralization were also collected.

Results: After removing duplicates, 199 resources from Google and Yahoo and 33 from Facebook were reviewed. Resources ranged from 2005 to 2021 and were primarily authored by registered dietitians and medical doctors (65% and 31%, respectively). Dietary advice mostly focuses on restricting high-phosphorus foods and phosphorus additive-based processed foods. Dietary restrictions were generally consistent with the traditional low-phosphorus diet, which targets whole grains, dairy, and plant-based protein foods, although major inconsistencies were noted. Phosphorus bioavailability and demineralization were rarely mentioned (16% and 8%, respectively). Similar findings were found on Facebook, but the limited number of resources limited meaningful comparisons.

Conclusion: Results showed that online resources for phosphorus-specific nutrition therapy are highly restrictive of heart-healthy food items and contain significant inconsistencies. Given the widespread and increasing use of online resources by people with CKD and health care professionals to inform dietary choices, efforts are urgently needed to establish consensus for phosphorus-specific nutrition therapy. Until then, the findings of this study provide a basis for increasing awareness of the potential for confusion arising from online resources.

Keywords: Chronic kidney disease; hyperphosphatemia; low-phosphorus diet; online resources.