Nephrologists and dietitians spend a significant amount of their time managing hyperphosphatemia. Phosphorus retention, which occurs in moderate to advanced CKD, is thought to contribute to secondary hyperparathyroidism and excessive vascular calcification. Diet counseling to reduce phosphorus intake is usually the first step in management. In most cases, however, the physician feels compelled to prescribe a so-called “phosphorus binder” to reduce GI absorption of phosphorus in the food.