PTH and hyperphosphatemia: In India, Desoky et al. found 83% of pediatric patients on RRT with high PTH, hypocalcemia, and hyperphosphatemia.27 In the 2018 Brazilian Dialysis Census, which also included the adult population on dialysis, 36% had inadequate PTH and 32% had hyperphosphatemia.28 Difficulty in controlling PTH levels is common in developing countries, where access to dietary phosphate binders is not universal.