Work

Short-term effects of therapeutic diet on bone turnover markers in hemodialysis patients: an exploratory analysis of a randomized crossover trial

Year: 2026

Type: article

Abstract: Bone turnover abnormalities are common in patients undergoing hemodialysis and contribute to fracture, vascular calcification, and mortality. Although therapeutic diets targeting phosphate balance improve mineral metabolism, their short-term effects on bone turnover remain unclear. In this post hoc analysis of a randomized crossover trial, 30 adults undergoing thrice-weekly hemodialysis received either a 7-day dialysis-specific therapeutic diet or their usual diet. The therapeutic diet emphasized a lower phosphorus-to-protein ratio, higher plant-based content, and increased fiber. Serum bone-specific alkaline phosphatase (BAP), osteocalcin, procollagen type 1 N-terminal propeptide (P1NP), C-terminal telopeptide of type I collagen (CTX), and tartrate-resistant acid phosphatase 5b (TRACP-5b) were assessed at baseline and on days 2, 5, and 7 of each phase. Mixed-effects models assessed associations between dietary phosphorus intake and bone turnover markers. The therapeutic diet significantly increased BAP levels after 7 days (median difference: + 0.8 μg/L, P = 0.02), but did not alter other markers. In multivariate models, a 100 mg reduction in dietary phosphorus intake corresponded to a 0.9% increase in BAP, 2.8% in P1NP, and 1.7% in TRACP-5b. Despite the small sample size and brief intervention, these findings suggest that short-term dietary phosphorus restriction may influence bone formation and resorption markers in hemodialysis patients.

Source: Scientific Reports

DOI: 10.1038/s41598-026-39820-w