Stuart M. Homer MD and Associates

Kidney Disease Education |

Phosphorus and the kidney diet


Phosphorus is a mineral that is vital for good health, since it is needed by every cell in your body for normal function. It is a major component of your bones and teeth and also assists your body in:

  • secreting hormones
  • storing and producing energy
  • utilizing B vitamins
  • controlling pH balance
  • delivering oxygen to your tissues
  • supporting the health and growth of connective tissues and organs

When your kidneys are not working as they should, they often cannot remove excess phosphorus from your bloodstream, and so phosphorus can build to unhealthy levels.

Excess phosphorus can cause calcium to leach from your bones so that over time they may weaken and break. And, if you have high levels of both phosphorus and calcium, damaging calcium deposits can form in soft tissues including your heart, lungs, eyes and blood vessels. That’s why, if you are diagnosed with chronic kidney disease (CKD), you’ll need to monitor and control the levels of both phosphorus and calcium in your body.

Generally, the recommended daily amount of phosphorus for adults is between 800 mg and 1,200 mg. Many foods provide phosphorus, so it is easy to get enough for good health. Very few people suffer from phosphorus levels that are too low. This is especially true now that Americans are eating more restaurant and fast foods, more canned and bottled drinks, packaged and prepared foods. Since food additives often contain phosphorus, the rise in consumption of processed foods has contributed to an accompanying rise in phosphorus in the American diet. In fact, in the last 20 years, Americans’ consumption of this mineral has risen 10 to 15 percent.

If you are on dialysis, your health care provider will do monthly laboratory tests to check your blood phosphorus level. For non-dialysis patients normal phosphorus is 2.7-4.6 mg/dL. For dialysis patients a healthy range is 3.0 to 5.5 mg/dL. Levels greater than 5.5 are associated with increased calcifications and renal-related bone disease.

The role of dialysis in phosphorus control

Dialysis will remove some phosphorus from your bloodstream, but it is important to realize that you must also keep your phosphorus levels in check between dialysis treatments. One important step in managing phosphorus is to eat a diet that helps limit your intake of the mineral. Your renal dietitian can provide lists of what foods to include in your food plan and what foods should be limited or avoided altogether.

When your goal is to limit your phosphorus intake, you cannot rely on reading food nutrition labels alone to alert you to foods that contain it, since food labels are not required by law to list the mineral. If you check the ingredients and see variations of the word phosphorus – including pyrophosphate, polyphosphates, phosphoric acid, calcium phosphate and sodium aluminum phosphate – then you will know the food is high in phosphorus and should be avoided. Foods that have 'high in calcium' on the label are often high in phosphorus too.

In many cases, people with kidney disease will be prescribed phosphate binders to assist in controlling phosphorus in the body. A phosphate (or phosphorus) binder works to absorb (bind) phosphorus in your stomach and gastrointestinal track rather than allowing it to pass into your blood. The mineral is then eliminated in the stool.

If your health care provider prescribes phosphate binders, you will also be instructed on how and when to take them. Typically, they are taken right before or after eating meals or phosphorus-containing snacks because binders work during digestion.

Foods high in phosphorus

Most of the phosphorus in your low phosphorus diet will come from important protein foods such as meat, poultry, fish, eggs and small amounts of dairy products. These foods provide the high quality protein your body needs.

To avoid consuming too much phosphorus, your dietitian may recommend that you avoid or limit these high-phosphorus foods and beverages:

  • milk, drinks made with milk, yogurt, cheese, cottage cheese, pudding and ice cream
  • beef liver, chicken liver and other organ meats
  • processed meats with phosphate additives
  • sardines, canned salmon or other fish canned with bones
  • dried beans and peas, such as lentils, split peas, lima beans, baked beans, kidney beans, black beans, chick peas, black-eyed peas and garbanzo beans
  • whole grain products, such as whole wheat bread and bran cereals
  • nuts and seeds
  • pizza
  • colas
  • cocoa and other chocolate drinks
  • ale and beer
  • bottled or canned iced tea, lemonade or other drinks with phosphate additives
Eat this, not that

You can avoid high-phosphorus foods and still enjoy a satisfying meal plan. The chart below provides some tips for making smart, low-phosphorus choices that are compatible with a kidney-friendly diet.

Fresh or fresh frozen meat, fish and poultry without phosphate additives
White rice, pasta, grits or couscous seasoned with margarine and herbs
Green beans or wax beans
Non-dairy creamers, soy milk, rice milk without phosphate additives
Cereals made from rice, corn, or refined wheat
French, Italian or white bread
Butter, margarine, honey, jam, jelly or cream cheese
Cream cheese, sour cream
Cream soda, lemon-lime soda, grape soda, homemade lemonade, homemade iced tea or root beer
Sorbet, sherbet, gelatin, nondairy frozen desserts
Jelly beans, fondant, gum drops, hard candy, unsalted popcorn or unsalted pretzels
Cookies or cake made without chocolate or nuts, such as sugar cookies, shortbread cookies, vanilla wafers or vanilla, lemon or angel food cake
Hot apple cider or hot spiced cranberry juice
Instead Of
Processed meats, canned fish with bones and poultry
Brown rice or wild rice
Dried beans or peas
milk or milk substitutes with phosphate additives
Cereals made from oats, bran or whole wheat
Whole grain breads
Peanut butter
Cheese and processed cheese products
Cola drinks, bottled or canned drinks with phosphate additives
Ice cream
Chocolate candy or nuts
Chocolate cookies or cake
Hot chocolate or cocoa