title: Optimal management of hyperphosphatemia in end-stage renal disease: an Indian perspective.
abstract: There has been an exponential increase in the incidence of diabetes and hypertension in India in the last few decades, with a proportional increase in chronic kidney disease (CKD). Preventive health care and maintenance of asymptomatic chronic disease such as CKD are often neglected by patients until they become symptomatic with fluid retention and uremia. Management of hyperphosphatemia in CKD remains one of the challenges of nephrology in India for this reason, as it is almost completely asymptomatic but contributes to renal osteodystrophy, metastatic vascular calcification, and acceleration of cardiovascular disease. Lack of understanding of the dangers of asymptomatic hyperphosphatemia, the huge pill burden of phosphate binders, difficulty with dietary and dialysis compliance, and most importantly, the added expense of the drugs places additional road blocks in the treatment of hyperphosphatemia at a population level in developing countries like India. In this review we seek to address the contribution of hyperphosphatemia to adverse outcomes and discuss economic, cultural, and societal factors unique to the management of phosphate levels in Indian patients with advanced CKD.
authors.affiliation: Department of Cardiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Yogesh Nv
authors.initials: YN
authors.lastname: Reddy
authors.affiliation: Department of Cardiology, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Varun
authors.initials: V
authors.lastname: Sundaram
authors.affiliation: Department of Nephrology, Madras Medical Mission, Chennai, India.
authors.forename: Georgi
authors.initials: G
authors.lastname: Abraham
authors.affiliation: Department of Nephrology, Madras Medical Mission, Chennai, India.
authors.forename: Prethivee
authors.initials: P
authors.lastname: Nagarajan
authors.affiliation: Department of Nephrology, Madras Medical Mission, Chennai, India.
authors.forename: Yuvaram Nv
authors.initials: YN
authors.lastname: Reddy
keywords: chronic kidney disease; dialysis; vascular calcification