Problems in adapting the K/DOQI guidelines for Japanese patients with end stage renal failure

The National Kidney Foundation published The K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease. We should also consider differences in clinical features of management for renal osteodystrophy between Japan and the USA. The first problem is related to a difference in the method of Ca correction. The second problem is related to a difference in the timing of measurement. In the USA the timing of measurement varies with each institution. Briefly, it is performed at midweek (2 days after the last dialysis) in some of institutions, while at the beginning of next week (3 days after the last dialysis) in some others. In addition, differences in the dose and type of the calcium-containing phosphorus adsorbent and active vitamin D used should also be taken into consideration.