A patient with CKD has a low-phosphate diet. Which food should be avoided?

• A. Dairy products
• B. Apples
• C. White rice
• D. Dairy products and phosphate-added processed foods

Answer: (D)

In CKD, keeping serum phosphate under control is essential because the kidneys can’t excrete phosphate efficiently, leading to hyperphosphatemia and bone-mineral problems. The most impactful way to cut phosphate intake is to avoid foods that are high in phosphate, especially those with inorganic phosphate additives. Dairy products naturally contain phosphate and contribute significantly to the phosphate load, and many processed foods include phosphate additives that are highly absorbable. Because of this, avoiding both dairy products and phosphate-added processed foods yields the greatest reduction in phosphate intake.

Apples and white rice tend to be lower in phosphate and contain phosphate that is less impactful in typical portions, so they’re less of a concern on a low-phosphate plan. Reading labels for phosphate additives and working with a dietitian to tailor choices helps manage CKD-related mineral balance.