Multidisciplinary team care for CKD-MBD. Achieving KDIGO guideline recommendations in the bundling era

The increasing prevalence of end-stage renal disease and planned expansion of the Medicare bundled payment system will place a greater financial burden on dialysis providers. Management of chronic kidney disease mineral and bone disorder (CKD-MBD) is dependent on interdisciplinary team (IDT) interventions such as dietary modification, medication, and adequate dialysis therapy. Optimizing adherence to diet and medications requires an educated and motivated IDT, patient, and patient support system. The financial constraints of bundling will increase the roles of social workers and dietitians in promoting therapy adherence. Innovative and relevant tactics provide opportunity to overcome monotonous routines, encourage adherence to diet and complex polypharmacy regimens, and achieve recommended biochemical targets as outlined in Kidney Disease Improving Global Outcomes Guideline for Chronic Kidney Disease (KDIGO) - CKD-MBD.