Lynn, a DaVita renal dietitian in Maryland, conducted a study involving people on hemodialysis who substituted liquid egg whites for meat. Her hope was that doing this would help dialysis patients keep their protein or albumin levels up while controlling phosphorus levels and reducing the amount of phosphorus binders patients would have to take.
Albumin is the most common protein found in the blood. It provides the body with the protein needed to both maintain growth and repair tissues. During a dialysis treatment, the albumin in your blood also helps with fluid removal. Albumin helps “pull” extra fluid from swollen tissues back into the blood, where it can then be removed by dialysis. Kidney Disease Outcomes Quality Initiative guidelines, from the National Kidney Foundation, recommends that a blood albumin level be 4.0 g/dl or higher. That is also DaVita’s goal for all dialysis patients.
Albumin is found in foods that contain protein. Foods from animals (beef, pork, fish, chicken, eggs, milk, etc.) contain the best sources of high quality protein. Lower quality protein comes from foods such as nuts, beans, vegetables and grain products. However, phosphorus is abundant in protein foods such as meats, dairy products, nuts and dried beans, and people with kidney disease need to follow a low-phosphorus kidney diet. In fact, most people on dialysis have to follow a low phosphorus diet and take phosphorus binders when they eat so that too much phosphorus does not enter their bodies. Phosphorus binders prevent the body from absorbing the phosphorus from the food you eat.
Lynn got the idea for the egg white study from one of her patients on hemodialysis who consumed eight ounces of liquid pasteurized egg whites a day.
“He seemed to have an excellent albumin level and was on very little phosphorus binders,” she said. “He and I discussed this, and we felt that it was due to this replacement in his diet. After eating like this for months, his labs still remained excellent. We discussed this with the Medical Director and concluded this would be an excellent research study. There was very little research on pasteurized liquid egg whites in relation to phosphorus in dialysis patients.”
Lynn then applied for, and received, a DaVita research grant to perform a research study on the effect of egg whites to lower phosphorus levels. Her goal was to find a way for people on dialysis to get enough protein to keep their albumin levels up while keeping phosphorus in the normal range and reducing their need for phosphorus binders.
In Lynn’s study, hemodialysis patients substituted eight ounces of pasteurized liquid egg whites for meat during one meal a day for six weeks. Original recipe ideas were provided for smoothies and for cooking. Pasteurized egg whites were used instead of fresh egg whites because the pasteurized product is salmonella-free and can be consumed without cooking if desired. The patients kept a daily meal diary for the duration of the study using a pictorial food log. Phosphorus binder intake was recorded. For each patient, phosphorus and blood albumin levels were measured at the beginning of the study. These were then averaged and compared to the average measurements collected at follow-ups.
The dialysis patients found parts of the study both easy and difficult. They found the recipes easy to make and enjoyable, and they particularly liked the smoothie recipes. However, some people who did not have large appetites found it difficult to consume eight ounces of cooked whites at one time. At the beginning, some also felt that it was hard to remember to keep their logs. This became easier as they got used to it.
Overall, Lynn found that 92 percent of dialysis patients in the study decreased their phosphorus levels when they substituted liquid egg white for meat in one meal a day for six weeks. When asked what she thinks renal dietitians and patients can learn from her findings, Lynn listed three things:
The kidney-friendly recipes used in the study were:
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