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.
Data availability
Deidentified participant data will be made available upon request by emailing the corresponding author. The data will be available for 3 years after publication.
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Acknowledgements
We would like to thank the staff of Far Eastern Memorial Hospital and particularly the study assistant, Yi-Han Lin, for providing assistance in conducting the study; the staff of the Dietary Department, including the dietitians (Yu-Chuan Lai, Chia-Hui Chou, Pei-Ying Chen, and Hsiao-Yuan Su) for maintaining the dietary records; and the chefs (Chuan-Yu Fu, and Shun-Ching Hsiao) for cooking the study foods. We also thank Pei-Lin Chen for collecting blood samples and the staff of Clinical Pathology Department for performing the automated bone turnover markers assays.
Funding
This study was supported by research grants to Dr. Wan-Chuan Tsai from the Far Eastern Memorial Hospital, New Taipei City, Taiwan (FEMH-2019-C-031, FEMH-2020-C-018, FEMH-2021-C-044, FEMH-2022-C-007, FEMH-2023-C-008, FEMH-2024-C-011, and FEMH-2025-C-008). The funders had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review, and approval of the manuscript; or the decision to submit the manuscript for publication.
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Yu-Sen Peng: Conceptualization, Formal analysis, Methodology, Resources, Supervision, Writing (original draft), Writing (review & editing) Wen-Huei Sun: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Writing (original draft), Writing (review & editing) Hon-Yen Wu: Conceptualization, Formal analysis, Methodology, Software, Supervision, Writing (review & editing) Yen-Ling Chiu: Data curation, Formal analysis, Investigation, Project administration, Writing (review & editing) Ju-Yeh Yang: Data curation, Investigation, Project administration, Writing (review & editing) Mei-Fen Pai: Data curation, Formal analysis, Investigation, Project administration, Writing (review & editing) Shih-Ping Hsu: Conceptualization, Methodology, Resources, Supervision, Writing (review & editing) Wan-Yu Lin: Conceptualization, Formal analysis, Methodology, Software, Writing (review & editing) Fang-Yeh Chu : Conceptualization, Data curation, Methodology, Validation, Writing (review & editing) Wan-Chuan Tsai: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Software, Writing (original draft), Writing (review & editing).
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Peng, YS., Sun, WH., Wu, HY. et al. Short-term effects of therapeutic diet on bone turnover markers in hemodialysis patients: an exploratory analysis of a randomized crossover trial. Sci Rep (2026). https://doi.org/10.1038/s41598-026-39820-w
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DOI: https://doi.org/10.1038/s41598-026-39820-w
