The nurse is caring for a client with end stage kidney disease (ESKD) on dialysis. The client asks why milk, chocolate milk, and soft drinks are not allowed in the diet order. The nurse explains that these foods should be avoided to decrease the risk of which conditions?


• In clients with significant kidney disease, the kidneys do not excrete enough phosphate. Dialysis helps clear the blood of waste products, urea, and creatinine, and uric acid, but does not remove phosphate effectively. For this reason, clients with severe kidney disease  are at risk for hyperphosphatemia even when they are given dialysis.

• Hyperphosphatemia is treated by reducing dietary intake of phosphate and by administration of drugs called phosphate-binders, which reduce absorption of dietary phosphate.
Foods that are high in phosphate, such as milk, egg yolks, chocolate, and soft drinks, are avoided. Other foods that are high in phosphate include organ meats, dried beans, bran cereals, and beer.

• As phosphate levels rise, serum calcium lowers as the calcium is consumed in the formation of calcium phosphate. Phosphate also inhibits vitamin D hydroxylation by the kidneys. Vitamin D acts to increase dietary calcium absorption, so hyperphosphatemia contributes to hypocalcemia in this way, as well.

• Hyperphosphatemia alone does not usually cause symptoms, but in clients with kidney disease, high phosphate accompanies low calcium.  Hypocalcemia can cause muscle cramps and spasms (tetany), tingling (often in the face or fingers), seizures, or abnormal heart rhythms.

• Hypernatremia is associated with kidney disease, but sodium levels are not affected much by these foods. High sodium and the excess fluid that goes along with it is managed with dialysis.

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