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Optimal management of hyperphosphatemia in end-stage renal disease: an Indian perspective

Authors Reddy Y, Sundaram V, Abraham G, Nagarajan P, Reddy YNV

Received 14 July 2014

Accepted for publication 23 August 2014

Published 23 October 2014 Volume 2014:7 Pages 391—399


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4

Editor who approved publication: Professor Pravin Singhal

Yogesh NV Reddy,1 Varun Sundaram,2 Georgi Abraham,3 Prethivee Nagarajan,3 Yuvaram NV Reddy3

1Department of Cardiology, Mayo Clinic, Rochester, MN, USA; 2Department of Cardiology, University Hospitals Case Medical Center, Cleveland, OH, USA; 3Department of Nephrology, Madras Medical Mission, Chennai, India

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.

Keywords: dialysis, chronic kidney disease, vascular calcification

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