Phosphate binders only bind phosphate that is in the gut at the same time, so they need to be taken with meals and snacks, not on an empty stomach or all at once in the morning. Many patients take them wrongly.
Much of the phosphate in modern diets comes from additives in processed foods, cola drinks and processed meats, and inorganic additive phosphate is absorbed more completely than phosphate from natural foods. Dietary advice that focuses only on dairy and pulses misses this, and can restrict protein unnecessarily.
- Ask how and when the patient takes binders; they must be taken with food.
- Point out phosphate additives in processed foods, colas and processed meats.
- Avoid restricting protein unnecessarily when addressing phosphate.
- Involve a renal dietitian where phosphate remains high.
Why it matters
Binder timing and processed-food phosphate are the commonest fixable reasons for persistently high phosphate.
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