Phosphorus plays a key role in the development of abnormal mineral and bone metabolism in chronic kidney disease (CKD-MBD). Patients with chronic kidney disease have an imbalance in phosphorus metabolism, and when the net phosphorus load absorbed by the intestine exceeds that removed by renal excretion or dialysis, the patient’s blood phosphorus rises above 4.5 mg/dL (1.46 mmol/L), which is considered hyperphosphatemia. Thus, the dietary load of phosphorus should not be ignored, and dietary phosphorus restriction measures for patients with chronic kidney disease are very important, both in the early stages of chronic kidney disease and in the progression of the disease until dialysis-dependent end-stage renal disease. Summary of dietary strategies for patients with chronic kidney disease Although the importance of dietary phosphorus restriction in patients with chronic kidney disease is well known, its implementation in clinical practice and in daily life is very challenging. Patients with kidney disease are subject to perhaps the most restrictive diets of all disease categories, and excessive restriction of protein nutrition may also create a risk of malnutrition. In addition, due to individual differences in dietary habits, philosophy, and literacy, hemodialysis patients do not pay enough attention to phosphorus-restricted diets and have poor compliance, which also makes dietary treatment more difficult. Recent studies have found that dietary phosphorus restriction is not a single restriction of high phosphorus (high protein) diet, but reasonable food selection and modification of food phosphorus content can help to effectively reduce dietary phosphorus load in patients with chronic kidney disease. In previous issues, we have discussed with you the details of these dietary strategies, which are summarized as follows: 1. choose foods with low phosphorus bioavailability to reduce dietary phosphorus absorption; 2. reject food additives and processed foods to avoid inorganic phosphorus intake; 3. choose low phosphorus and high protein foods to maintain nutritional needs while reducing dietary phosphorus intake; 4. use the “boiling” cooking method to reduce animal foods; 5. “cooking method to reduce the source of phosphorus in animal food. A recent study from Italy found that patients with chronic kidney disease who received gradual, individualized nutritional support for 3 years had reduced blood phosphorus and blood urea nitrogen levels, and maintained blood albumin levels. Recommendations for the Hyperphosphatemia Diet Pyramid Finally, we recommend the latest Hyperphosphatemia Diet Pyramid from Italy, which is based on existing nutritional databases and food phosphorus content, bioavailability and processing methods.