K/DOQI guidelines for bone metabolism and disease in chronic kidney disease patients: some therapeutic implications

The National Kidney Foundation (NKF) has recently published clinical practice guidelines for bone metabolism and disease in chronic kidney disease (CKD) patients (the Kidney Disease Outcomes Quality Initiative [K/DOQI]). Data from the literature show that the majority of dialysis patients treated with traditional calcium-containing phosphorus binders and vitamin D or vitamin D analogue preparations have serum parathyroid hormone (PTH), calcium, and phosphorus levels outside these strict K/DOQI target ranges. In fact, it appears that achieving and maintaining the targets values set by these guidelines is virtually impossible without the simultaneous use of the new calcimimetic agents and non-calcium-containing binders, agents that have significant cost barriers to their use in many patients. These guidelines are welcome, but they may be impractical for the majority of dialysis patients. The impact of these guidelines in improving the parameters of bone metabolism and disease among dialysis patients remains to be determined.