Hyperphosphatemia in endstage renal disease patients has been associated with greater risk of mortality, especially due to cardiovascular causes (1). Most commonly, nephrologists employ an approach of dietary phosphorus restriction, use of phosphate binders and hemodialysis, to facilitate maintenance of serum phosphate levels in dialysis patients. A majority of Indian dialysis patients receive two/week hemodialysis sessions, as against three/week in the Western world. Indian diet is vastly different from typical Western diet and various regional differences exist too. Dietary modifications to increase protein and minimize phosphorus intake, are only variably successful, as cost and logistics play greater role in deciding the patient’s diet, rather than the clinician’s advice (1). Therefore, the onus of phosphate removal falls upon a combination of phosphate binders and the hemodialysis sessions.

Brief review: Regarding dialytic phosphorus removal, available literature is unclear whether short, frequent hemodialysis sessions are more beneficial than prolonged sessions in reducing serum phosphorus levels (2,3). To our knowledge, only a single study has evaluated dialytic phosphorus removal over a period of time (4). This study found out that while the first hour of hemodialysis normalizes serum phosphorus levels, significant amount of phosphorus continues to be removed in the subsequent hours as well. The present study will observe dialysis phosphorus removal at hourly intervals and help in deciding which approach will tackle hyperphosphatemia  effectively – increasing dialysis duration or frequency. Moreover, no other study has undertaken the evaluation of dietary phosphorus intake and dialytic phosphorus removal in an Indian population before.