Use of a Phosphorus Points Education Program to Maintain Normal Serum Phosphorus in Pediatric Chronic Kidney Disease: A Case Report

A 14-year-old male, with chronic kidney disease stage 4 (glomerular filtration rate
20 mL/min/1.73 m
²) secondary to reflux nephropathy required dietary modification with evidence of renal
osteodystrophy, presented with elevated serum phosphorus and parathyroid hormone.
He was educated using a novel phosphorus point system where 1 point is equivalent
to ∼50 mg of phosphorus. Dietary counseling was provided by a pediatric renal dietitian
on phosphorus content of foods the patient typically consumed and converted to point
system for daily tracking. The family reported limiting daily phosphorus points to
less than 20 points daily for 15 months. The family completed a 3-day food record
and provided points assigned to each food item. A Spearman’s correlation of 0.7 (
P < .001) was found between the family's and the dietitian's assignment of phosphorus points. The patient's recorded phosphorus intake remained below 1000 mg each day and met estimated calorie and protein needs. The patient also continued with age-appropriate weight gain and linear growth. Laboratory values showed phosphorus and intact parathyroid hormone remained within desired range. A phosphorus point system tool can be used to maintain normal serum phosphorus levels and subsequently prevent secondary hyperparathyroidism in patients with pediatric chronic kidney disease.