Expert Perspectives on Hyperphosphatemia Management in CKD: A Focus on Sucroferric Oxyhydroxide and Phosphate Binders
Umesh B Khanna1, Prem Prakash Varma2, Tarun K Jeloka3, A K Bhalla4, Deodatta S Chafekar5, Umapati N Hegde6, Manoj K Singhal7, Sunil Prakash8, Sanjeev Gulati9, Manju Aggarwal10, Raj Kumar Sharma11, Rajasekara Chakravarthi12, Rajan Ravichandran13, Sanjeev Kumar Hiremath14, Anupam Roy15, Rajesh R Nair16, Sanjay Srinivasa17, Apoorva Jain18, Umang Kasturi19
1Consultant Nephrologist, Founder & Director of Kidney Associates, Mumbai, Maharashtra.
2Chairman, Dept of Nephrology, Primus Hospital, New Delhi
3HOD, Manipal Hospitals, Baner, Pune, Maharashtra
4Chairman & HOD, Department of Nephrology, Sir Ganga Ram Hospital, New Delhi
5Supreme Kidney Care, Nashik
6Muljibhai Patel Urological Hospital, Nadiad, Gujarat
7Principal Director - Nephrology and Kidney Transplantation, Max Super Speciality Hospital New Delhi
8Principal Director & HOD, Department of Nephrology & Transplant Service, BLK - Max Super Speciality Hospital, New Delhi
9Executive Director and Head, Nephrology at Fortis Hospitals, Vasant Kunj, New Delhi.
10Chairperson, Department of Nephrology and Kidney Transplantation, Artemis Health Institute, Sector 51, Gurgaon.
11Director & Head Department of Nephrology & Kidney Transplant Medicine, Medanta Kidney & Urology Institute, Lucknow.
12Clinical Director & HOD Nephrology & Transplant services, Yashoda Hospitals, Hitec City, Hyderabad, Telangana
13Director nephrology, MIOT International, Chennai
14Consultant Nephrologist, Sagar Hospitals, Bengaluru
15Associate Director, Department of Nephrology & Renal Transplant, Venkateshwar Hospital, New Delhi
16Professor and HOD of Nephrology Amrita Institute of Medical Sciences and Research Centre Amrita School of Medicine Kochi.
17Consultant Nephrologist, Dr Sanjay"S Center For Kidney and Diabetes, Bengaluru
18Professor and Head, Dept. of Nephrology, Sarojini Naidu Medical College, Agra, UP
19Nephrologist at Sir Ganga Ram Hospital, New Delhi
Calcium and phosphorus homeostasis is crucially regulated by interactions between the kidneys, intestines, and bones, with key hormones like vitamin D, parathyroid hormone (PTH), and fibroblast growth factor 23 playing central roles. As chronic kidney disease (CKD) advances, especially to end-stage renal disease (ESRD), this balance is disrupted, leading to hyperphosphatemia, characterized by serum phosphorus levels >4.5 mg/dL. Hyperphosphatemia is a significant risk factor for cardiovascular complications and mortality in CKD patients, with prevalence ranging from 21% to 40% in those on dialysis, varying by region due to dietary patterns and dialysis practices.
Effective management includes dietary phosphorus restriction and phosphate binders(PBs). Sucroferric oxyhydroxide (SO), an iron-based PB, has shown promise due to its ability to reduce serum phosphorus with a lower pill burden compared to alternatives like sevelamer. This expert opinion aimed to guide SO use in CKD patients with hyperphosphatemia. The experts from various regions of India convened for a structured discussion moderated through live polling. Key insights emphasized that SO is effective, well-tolerated, and cost-effective, offering improved patient adherence due to reduced pill burden.
This guidance is intended to enhance treatment strategies, optimize patient outcomes, and address gaps in current clinical practice for managing hyperphosphatemia in CKD.
DOI: 10.29245/2767-5149/2025/2.1125 View / Download PdfFactors Associated with Acute Kidney Injury in Cirrhotics Patients at the Departmental University Hospital of Borgou and Alibori (Benin)
Séraphin Ahoui1*, Khadidjatou Sake Alassan2, Féïchola Audrey Marina Hounkpatin2, Giovanna Zossoungbo3,Nicolas H. Amegan2,Evariste Eteka1,Nicanor Houeto1,Aimé Vinasse1, Joseph Godonou1, Missikè Aubin Melikan1, Jacques Vigan3, Moutawakilou Gomina4
1Department of Nephrology, Faculty of Medicine, University of Parakou, Parakou, Benin
2Department of hepatogastroenterology, Faculty of Medicine, University of Parakou, Bénin
3Department of Nephrology, Faculty of Health Sciences, University of Abomey Calavi, Benin
4Department of Medical Biology, Faculty of Medicine, University of Parakou, Bénin
Introduction: Acute kidney injury is one of the major complications that can occur during liver cirrhosis.
Objective: to study the frequency and factors associated with acute kidney injury in CHUD-B/A cirrhotic patients in 2022.
Patients and methods: This was a cross-sectional, descriptive study with prospective data collection over a period from February 1 to June 30, 2022. A systematic recruitment of cirrhotic patients received in consultation and in hospitalization was made. AKI was defined according to the ADQI- IAC classification. Statistical analysis was performed using SPSS 21 software. The association between the identified factors and the variable of interest was determined by the Odds Ratio (OR) and its 95% confidence interval.
Results: A total of 73 cirrhotic patients were included and 14 of them had AKI. The frequency of AKI in cirrhotics was 19.2%. The mean age was 48.6 ± 16.9 years with a sex ratio of 13. Factors associated with AKI were hepatic encephalopathy (p=0.006) and Child-Pugh C score (p=0.031).
Conclusion: Acute kidney injury among cirrhotic patients is highly frequent. Its screening should be systematic for cirrhosis patients in order to improve their medical care and survival.
DOI: 10.29245/2767-5149/2025/1.1124 View / Download PdfPatient Perspectives: The Effects of Contemporary Phosphorus Management on Quality of Life
Michael Levy1*, Alex Berrios2
1Patient Advisory Council, Satellite Healthcare
2Engagement Specialist, Interwell Health
Effective regulation of phosphate levels is essential for managing the health of the nearly 600,000 dialysis patients in the United States, over 43% of whom exceed the recommended serum phosphate target of 5.5 mg/dL. Current phosphate binders present significant challenges, including large pills that are hard to swallow, pills that require thorough chewing, which may be difficult for patients with impaired dentition, frequent dosing, gastrointestinal adverse effects, and the need to take them while in public, which can lead to non-adherence and reduced social eating. Coupled with stringent dietary restrictions, confusion over administration timing, and high medication cost, these factors severely compromise patients’ quality of life. Addressing these barriers requires a comprehensive strategy: clinicians must recognize the difficulties faced by patients, bridge knowledge gaps regarding dietary phosphorus, and explore novel therapies that reduce pill size and burden without sacrificing efficacy. By mitigating these challenges, healthcare providers can enhance treatment experiences, strengthen patient-clinician relationships, and ultimately improve overall quality of life for dialysis patients. With a focus on patients’ perspectives, this review highlights the critical need for patient-centered approaches in phosphate management to ensure better clinical outcomes and patient satisfaction.
DOI: 10.29245/2767-5149/2024/1.1121 View / Download Pdf