Public Health Approach to Addressing Hyperphosphatemia Among Dialysis Patients
Elevated serum phosphorus levels are a major source of morbidity and mortality for the 350,000 Americans receiving chronic dialysis treatment. Despite the widespread application of medical and behavioral interventions, the prevalence of hyperphosphatemia remains exceedingly high. At first glance, a public health perspective may seem inappropriate for addressing a disorder of mineral metabolism among patients receiving a life-sustaining treatment. However, we analyzed this topic from a public health perspective and identified many opportunities to improve the management of hyperphosphatemia, including (1) media and cultural messages about food, (2) the availability of appropriate foods and medications, (3) physical structures such as the location of products in grocery stores, and (4) social structures such as food-labeling laws.
This article has an online CPE activity available at www.kidney.org/professionals/CRN/ceuMain.cfm
∗Division of Nephrology, MetroHealth Medical Center, Cleveland, OH
†Department of Public Health, City of Cleveland, Cleveland, OH
‡Center for Reducing Health Disparities, Case Western Reserve University, Cleveland, OH
§Center for Health Care Research and Policy, MetroHealth Medical Center, Cleveland, OH
¶Department of Medicine, Case Western Reserve University, Cleveland, OH
#Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH
^Department of Bioethics, Case Western Reserve University, Cleveland, OH
Address reprint requests to Ashwini R. Sehgal, MD, Division of Nephrology, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109.
Supported by grant DK51472 from the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, and by the Leonard C. Rosenberg Renal Research Foundation, Cleveland, Ohio.
ABSTRACT