Dietary phosphorus restriction in predialysis chronic kidney disease: time for a cease-fire?

The increased awareness that disorders of phosphorus metabolism occur early in the course of chronic kidney disease fuels interest in early intervention strategies. A post hoc analysis of data from the Modification of Diet in Renal Disease (MDRD) Study questions the clinical relevance of early dietary phosphate restriction, so far considered a mainstay in the prevention and treatment of mineral metabolism disorders. Still, on the basis of available evidence, a cease-fire in the war on dietary phosphate would be premature.