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Dietary Phosphate Additives First-Line — ESENeph MCQ

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HardDiabetic Kidney DiseaseDietary Phosphate Additives First-LineESENeph

A dialysis patient has persistent hyperphosphataemia despite adherence to sevelamer. Dietary recall shows little dairy or red meat but daily processed cheese slices, cola and reconstituted meat products. What is the most useful next dietary intervention?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Target inorganic phosphate additives before restricting natural protein sources

Explanation lettering: B = shown as A · E = shown as B · A = shown as C · C = shown as D · D = shown as E

E is correct. Inorganic phosphate additives are highly bioavailable and can deliver a substantial hidden phosphate load in processed foods, cola and reconstituted products. KDIGO advises considering the source of dietary phosphate, not simply imposing indiscriminate protein restriction. Plant phosphate is generally less bioavailable because much is phytate-bound; excessive restriction can worsen malnutrition. Binder timing, dose and adherence should also be reviewed, but changing binder class without identifying a large additive load misses a reversible contributor. Calcium loading is not automatically preferable and depends on serial calcium, phosphate and PTH assessment.

Reference: KDIGO 2017 CKD-MBD guideline update: https://kdigo.org/wp-content/uploads/2018/04/2017-KDIGO-CKD-MBD-GL-Update.pdf