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, PhosEx, 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.
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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.
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Avoid foods high in phosphorus, including:
Liver
Wheat germ
Sunflower seeds
Pumpkin seeds
Foods to eat in moderation:
Milk
Nuts and seeds
Bran cereals
Chocolate
Meats
Muffins
Dairy products
Pizza
Legumes
Whole grains
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
Beef, round
Serving
3 ounces
Iron (mg)
1.9
Phosphorus (mg)
207
Hamburger
3 ounces
2.2
144
Veal, loin
3 ounces
1.6
192
Lamb, chop
1
1.6
107
Pork, center loin
3 ounces
0.7
168
Chicken, breast meat
3 ounces
0.9
198
Turkey
3 ounces
1.3
198
Liver, Beef
3 ounces
5.8
345
Fish
3 ounces
1
150-240
Tuna, canned
3 ounces
1.3
201
Lobster
3 ounces
1.2
156
Sardines, Atlantic
3 ounces
0.7
118
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Meat, Poultry, Fish
Oysters
Serving
4 medium
Iron (mg)
9.2
Phosphorus (mg)
79
Egg, yolk
1 each
0.6
86
Diary Products
Serving
Iron (mg)
Phosphorus (mg)
Milk, 2% or skim
2 cup
---
116
Cheese
1 ounce
0.2
145
Cottage Cheese, 2%
2 cup
0.2
170
Yogurt
2 cup
---
160
Ice Cream
2 cup
0.1
70
Pudding
2 cup
0.5
125-150
Custard
2 cup
0.4
150-170
Cream soup
2 cup
0.5
46-25
Chocolate milk
2 cup
0.3
128
Dried Beans
Navy beans
Serving
2 cup
Iron (mg)
2.4
Phosphorus (mg)
143
Kidney beans,
canned
2 cup
2.3
60
Lima beans, frozen
2 cup
1.2
101
Pinto beans, canned
2 cup
2
110
Black-eyed peas
2 cup
1.2
133
Lentils
2 cup
3.3
178
Soybeans
2 cup
4.4
210
Tofu, raw
2 cup
0.5
120
Nuts and Seeds
Serving
Iron (mg)
Phosphorus (mg)
Almonds, dried
1 ounce
1.1
148
Cashews, dry roasted
1 ounce
1.7
131
Coconut, dried
1 ounce
0.5
59
Pecans, dry roasted
1 ounce
0.6
86
Walnuts, English
7 each
0.7
90
Peanuts, dry roasted
1 ounce
0.6
100
Pumpkin seeds, roasted
1 ounce
0.9
333
Sunflower seeds, dry
roasted
1 ounce
1.1
328
Peanut butter
1 tablespoon
0.3
60
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Whole Grains
Serving
Iron (mg)
Phosphorus (mg)
Bran, unprocessed
Quaker
2 tablespoons
1.6
115
Bran Flakes
3/4 cup
18
139
Oatmeal, old
fashioned
2 cup
1.6
128
Barley
2 cup
1
221
Bran muffin
1 small
1.3
111
Brown rice
2 cup
0.4
71
Whole wheat bread
1 slice
0.9
65
White bread
1 slice
0.8
25
Wheat germ
1/4 cup
1.8
325
Raisin bran
3/4 cup
5
137
Other
Serving
Iron (mg)
Phosphorus (mg)
Carbonated colas
12 ounces
---
45-55
Chocolate
1 ounce
0.3
65
Cocoa powder
1 tablespoon
0.7
35
Caramel
1 ounce
0.4
35
Mushroom pieces,
raw
2 cup
0.4
36
Green peas, frozen
2 cup
1.3
72
Molasses, black
strap
1 tablespoon
3.3
17
Raisins
2/3 cup
2
97
Dates
10 each
1
33
Spinach, boiled
2 cup
3.2
50
Pizza, cheese, 15"
1/8th slice
0.6
216
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) 293-3707 or email: [email protected].