Phosphorus is an essential mineral involved in numerous physiological processes, including bone mineralization, energy metabolism (via ATP), acid-base balance, and cellular signaling. It is naturally abundant in many foods, particularly in protein-rich sources such as dairy products, meats, legumes, and nuts, as well as in processed foods containing phosphate additives. A low phosphorus diet is commonly prescribed for individuals with chronic kidney disease (CKD), particularly in stages 3–5, due to the kidneys' reduced ability to excrete phosphorus effectively. Hyperphosphatemia (elevated serum phosphorus) is a frequent complication in CKD and is associated with secondary hyperparathyroidism, vascular calcification, cardiovascular morbidity, and increased mortality. Managing dietary phosphorus intake is thus a cornerstone in the nutritional care of CKD patients. It aims to: Maintain normal serum phosphorus levels, prevent secondary complications like renal osteodystrophy and reduce dependence on phosphate binders. In clinical practice, phosphorus restriction involves limiting high-phosphorus foods, especially those containing inorganic phosphate additives, which are more readily absorbed (up to 90–100%) compared to organic phosphorus in natural foods (~40–60%). Dietitians often tailor phosphorus management plans while balancing other dietary needs, such as protein and calcium intake, to avoid malnutrition. Despite its clinical importance, adherence to a low phosphorus diet can be challenging due to the complexity of food sources, hidden additives, and lack of labeling regulations in many countries.
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