Iron and Phosphorus and Kidney Disease

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1 Iron and Phosphorus and Kidney Disease For people with kidney disease, it is important to get enough iron in the diet while not getting too much phosphorus. Kidney disease can cause problems with the growth of new red blood cells, so getting enough iron is important. Kidney disease can also cause phosphorus to build up in the body, causing other health problems. Many foods that are high in iron are also high in phosphorus. For good health, you will need to restrict the amount of phosphorus in your diet while getting enough iron. Iron Because kidney disease can cause problems with the growth of new red blood cells, your doctor may suggest that you take a medicine called Epoetin Alpha or Darbepoetin Alpha. This medicine causes your body to make red blood cells. Eating iron-rich foods and taking iron supplements make this medicine work better. Iron tablets may be taken 3 times a day, in between meals. Iron supplements can cause your stools to be black or tarry-looking. They may also cause constipation. Tell your health professional if you have trouble taking iron supplements. Following are some tips to help you better tolerate iron supplements: Avoid taking iron with a phosphate binder (calcium carbonate, Tums, Phos- Ex, Phos-Lo, Cal-Carb, calcium acetate) Large amounts of calcium bind with iron and make iron less available for absorption by the body. If a calcium binder is taken with meals, wait at least one hour after a meal before taking iron. Avoid taking iron with coffee or tea (wait at least one hour), as well as with milk. All of these foods decrease the amount of iron your body can absorb. Take the iron supplement with a snack such as unsalted crackers or toast to help prevent nausea. The iron in meat, poultry, and seafood is better absorbed by your body than the iron in non-animal foods like beans. Learn more about your health care. More on next page Copyright July 24, The Ohio State University Wexner Medical Center - Upon request all patient education handouts are available in other formats for people with special hearing, vision and language needs, call (614)

2 Page 2 Foods high in vitamin C will increase absorption of iron in your body. Examples include: Vitamin C fortified cranberry juice or ½ cup orange juice ½ cup mandarin oranges ½ cup strawberries Be sure to choose fruits or fluids within your meal plan and fluid restriction guidelines. Phosphorus Restrictions Why do I need to limit phosphorus? Phosphorus can build up in the body when your kidneys are not working well. Too much phosphorus in the blood can cause calcium to be pulled out of the bone. This calcium loss may lead to thinner and weaker bones. Itching, bone pain, red eyes, and scaled skin also can result from high phosphorus levels. Diet and medicines can control these conditions. It is important to get enough iron in your diet without getting too much phosphorus. How can I control my phosphorus levels? You can control your phosphorus levels by limiting high phosphorus foods in your diet. Medicines that bind with phosphorus also may be taken. These medicines prevent the phosphorus in food you eat from being absorbed into the blood. Examples of these medicines are calcium carbonate (Oscal, Tums), Alucaps and Carafate. These medicines work best if taken with meals Calcium supplements and medicines that bind with phosphorus may interfere with each other if taken at the same time. Ask your doctor for a laxative or stool softener if you have constipation. How much phosphorus do I need? As a general guideline, hemodialysis patients need to limit phosphorus intake to 800 mg a day, and continuous ambulatory peritoneal dialysis (CAPD) patients need to limit phosphorus to 1200 milligrams (mg) a day. Phosphorous content in foods Phosphorus is found in most foods. Common sources are milk, dairy products, cola beverages, meats, whole grains, chocolate, legumes, dried beans, nuts and seeds. Although meat is high in phosphorus, it should not be completely avoided since it is a good source of protein, iron and other nutrients you need. Eat moderate portions to help control the amount of phosphorus in your diet.

3 Page 3 Avoid foods high in phosphorus, including: Liver Sunflower seeds Foods to eat in moderation: Milk Chocolate Dairy products Legumes Nuts and seeds Meats Pizza Whole grains Wheat germ Pumpkin seeds Bran cereals Muffins Good sources of iron rich foods that are lower in phosphorus (these foods are high in potassium): Iron fortified cereals and breads avoid whole grains which are high in phosphorus Leafy green vegetables A Note about Potassium Potassium is a mineral the body needs to help the nerves and muscles work to regulate your heart beat. As with phosphorus, when the kidneys are not working as they should, potassium can build up and cause problems. Too much potassium can be especially harmful to the heart muscle. For more information on restricted potassium, see the handout Potassium Restricted Diet. Iron and Phosphorus content of selected foods Meat, Poultry, Fish Serving Iron (mg) Phosphorus (mg) Beef, round 3 ounces Hamburger 3 ounces Veal, loin 3 ounces Lamb, chop Pork, center loin 3 ounces Chicken, breast meat 3 ounces Turkey 3 ounces Liver, Beef 3 ounces Fish 3 ounces Tuna, canned 3 ounces Lobster 3 ounces Sardines, Atlantic 3 ounces

4 Page 4 Meat, Poultry, Fish Serving Iron (mg) Phosphorus (mg) Oysters 4 medium Egg, yolk 1 each Diary Products Serving Iron (mg) Phosphorus (mg) Milk, 2% or skim 2 cup Cheese 1 ounce Cottage Cheese, 2% 2 cup Yogurt 2 cup Ice Cream 2 cup Pudding 2 cup Custard 2 cup Cream soup 2 cup Chocolate milk 2 cup Dried Beans Serving Iron (mg) Phosphorus (mg) Navy beans 2 cup Kidney beans, canned 2 cup Lima beans, frozen 2 cup Pinto beans, canned 2 cup Black-eyed peas 2 cup Lentils 2 cup Soybeans 2 cup Tofu, raw 2 cup Nuts and Seeds Serving Iron (mg) Phosphorus (mg) Almonds, dried 1 ounce Cashews, dry roasted 1 ounce Coconut, dried 1 ounce Pecans, dry roasted 1 ounce Walnuts, English 7 each Peanuts, dry roasted 1 ounce Pumpkin seeds, roasted 1 ounce Sunflower seeds, dry roasted 1 ounce Peanut butter 1 tablespoon

5 Page 5 Whole Grains Serving Iron (mg) Phosphorus (mg) Bran, unprocessed Quaker 2 tablespoons Bran Flakes 3/4 cup Oatmeal, old fashioned 2 cup Barley 2 cup Bran muffin 1 small Brown rice 2 cup Whole wheat bread 1 slice White bread 1 slice Wheat germ 1/4 cup Raisin bran 3/4 cup Other Serving Iron (mg) Phosphorus (mg) Carbonated colas 12 ounces Chocolate 1 ounce Cocoa powder 1 tablespoon Caramel 1 ounce Mushroom pieces, raw 2 cup Green peas, frozen 2 cup Molasses, black strap 1 tablespoon Raisins 2/3 cup 2 97 Dates 10 each 1 33 Spinach, boiled 2 cup Pizza, cheese, 15" 1/8th slice If you have any questions or concerns talk with a dietitian, your kidney doctor or a nurse. Talk to your doctor or others on your health care team if you have questions. You may request more written information from the Library for Health Information at (614) or

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