The effects are exacerbated by immunosuppressive medications. Late post-transplant hypophosphataemia Metformin nmr is mainly related to persistent hyperparathyroidism.2 The clinical significance of hypophosphataemia varies depending on whether it develops in the early or late post-transplant period. In the short-term, the effects include muscle weakness and osteomalacia. In severe phosphate depletion, haemolytic anaemia, rhabdomyolysis, decreased myocardial contractility and respiratory failure may occur. Long-term

hypophosphataemia is associated with post-transplantation osteodystophy.3,4 This review set out to explore and collate the evidence for the efficacy of nutrition interventions in the prevention and management of hypophosphataemia in adult kidney transplant find more recipients, based on the best evidence up to and including September 2006. Relevant reviews and studies were obtained from the sources below and reference lists of nephrology textbooks, review articles and relevant trials were also used to locate studies. Searches were limited to human studies on adult transplant recipients and to studies published in English. Databases searched: MeSH terms and text words for kidney transplantation were combined with MeSH

terms and text words for both hypophosphataemia and dietary interventions. MEDLINE – 1966 to week 1 September 2006; EMBASE – 1980 to week 1 September 2006; the Cochrane Renal Group Specialised Register of Randomised Controlled Trials. Date of searches: 22 September 2006. Level I/II: There are no randomized controlled trials investigating the efficacy of nutritional interventions for treating hypophosphataemia in kidney transplant recipients. Level III: There is weak evidence from one pseudo-randomized controlled study that oral phosphate supplementation in the early post-transplant period helps to normalize serum phosphate concentration and muscle phosphate content after transplantation without affecting calcium or parathyroid hormone (PTH) metabolism. Oral phosphate supplementation Amino acid appears to prolong phosphaturia, increasing renal net acid

excretion thus helping to correct metabolic acidosis.1 Level IV: There is level IV evidence from one study that oral phosphate supplementation in the late post-transplant period (mean time since transplantation, 41 months) may increase PTH levels, potentially worsening hyperparathyroidism.5 In a pseudo-randomized, controlled study, Ambuhl et al.1 investigated the effect of oral neutral phosphate supplementation on serum muscle phosphate concentration, mineral metabolism, parathyroid hormone and acid/base homeostasis, in adult kidney transplant recipients with mild, early post-transplant hypophosphataemia. Twenty-eight kidney transplant recipients with stable renal function and serum phosphate levels of 0.3–0.