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CKD Phosphate Dietary Approach — ESENeph MCQ

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EasyChronic Kidney DiseaseCKD Phosphate Dietary ApproachESENeph

A 55-year-old man with CKD G3b (eGFR 38) has a serum phosphate of 1.7 mmol/L and PTH of 18 pmol/L. He is not yet on a phosphate binder. He has normal calcium. According to KDIGO 2017 CKD-MBD, what should be the approach to phosphate?

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Correct answer: A — Lower phosphate toward the normal range through dietary phosphate restriction first; add binder if diet alone insufficient

KDIGO 2017 CKD-MBD guideline recommends lowering elevated phosphate toward the normal range in CKD G3a-G5D. In CKD G3-G4 (pre-dialysis), the first step is dietary phosphate restriction (reducing processed foods with phosphate additives, limiting high-phosphate foods). Phosphate binders are added if dietary measures are insufficient. Phosphate of 1.7 mmol/L (upper limit normal ~1.5) is mildly elevated and warrants dietary counselling. Binders are more commonly needed in CKD G4-5.

Reference: KDIGO 2017 – CKD-MBD Guideline Update