A patient with chronic kidney disease has hyperphosphatemia. Which dietary modification is appropriate?

• A. Limit phosphorus intake and take phosphate binders with meals as prescribed.
• B. Increase phosphorus-rich foods to promote bone health.
• C. Avoid all dairy products.
• D. Use potassium supplements to bind phosphorus.

Answer: (A)

In chronic kidney disease, phosphate isn’t excreted well, so managing hyperphosphatemia means both limiting dietary phosphate and using phosphate binders with meals to prevent absorption. The best choice reflects this approach: limit foods high in phosphate and take phosphate binders with meals as prescribed. Phosphate binders work in the gut to bind dietary phosphate, forming an insoluble compound that is excreted in the stool, which helps keep serum phosphate from rising and reduces the risk of bone and mineral disorders. Increasing phosphorus-rich foods would worsen the problem, while avoiding all dairy is overly restrictive and not necessary for everyone. Using potassium supplements to bind phosphorus isn’t how this is managed and could cause dangerous potassium levels in CKD.