Hyperphosphatemia among end-stage renal disease patients in developing countries: a forgotten issue?

Area of Science:

• Nephrology
• Public Health
• Clinical Medicine

Background:

• Hyperphosphatemia and elevated calcium-phosphorus product are significant complications in chronic kidney disease (CKD) patients undergoing hemodialysis (HD).
• Limited data exists on the prevalence and contributing factors of hyperphosphatemia in large multicenter studies within developing countries.

Purpose of the Study:

• To determine the prevalence of hyperphosphatemia and high calcium-phosphorus product in CKD stage 5 patients on HD in Egypt.
• To correlate these findings with demographic data, co-morbidities, and dialysis parameters.

Main Methods:

• A cross-sectional study involving 1005 CKD stage 5 patients on HD for over one year across 38 centers in Egypt.
• Data collection included patient demographics, dietary knowledge, HD parameters (duration, frequency, membrane type, dialyzer surface area, phosphorus clearance), co-morbidities (including ischemic heart disease - IHD), and laboratory values.

Main Results:

• Hyperphosphatemia was observed in 69.1% of patients, and a high calcium-phosphorus product in 30.2%.
• Higher calcium-phosphorus product was noted in males. Poor dietary knowledge (83.2%) and low-to-medium clearance membranes (72.3%) were associated with increased hyperphosphatemia.
• Patients with IHD also showed a higher prevalence of hyperphosphatemia (72%).

Conclusions:

• Hyperphosphatemia is a substantial issue for dialysis patients in developing countries like Egypt.
• Factors contributing include dietary habits, ethnic influences, dialysis quality, membrane characteristics, and economic constraints limiting access to advanced phosphate binders.
• Strategies such as extended dialysis hours may offer a viable solution in resource-limited settings.