title: The renal dietitian's role in managing hyperphosphatemia and secondary hyperparathyroidism in dialysis patients: a national survey.
abstract: OBJECTIVE
  To survey the medical nutrition therapy practices of renal dietitians for the treatment of bone mineral metabolism.
  
  
  OBJECTIVE
  To obtain data on phosphorus diet prescription levels. To determine allied team involvement for phosphate binder and Vitamin D therapies. To assess the frequency and target levels for monitoring serum calcium, phosphorus, -phosphorus product, intact PTH and alkaline phosphatase.
  
  
  METHODS
  Two renal dietitians from the National Kidney Foundation-Council on Renal Nutrition developed a 5-question survey. This was posted on both the RenalRD Listserv and the NKF-CRN website from January 1 through February 15, 2001. Dietitians were asked to respond using facsimile, e-mail or reply by mail.
  
  
  RESULTS
  One hundred and thirty-one surveys were received representing all major dialysis providers in the United States, the British Virgin Islands, and Japan. Results included information for peritoneal and hemodialysis patients. Five different methods for dosing phosphate binders were determined. Prescribed phosphate binders included calcium acetate, sevelamer hydrochloride, and calcium carbonate. 108 out of 131 dietitian respondents (82.5%) have a medical protocol in place for vitamin D therapy. Of the respondents, 47% were directly responsible for implementing the vitamin D protocol. Paricalcitol was the most widely used form of IV Vitamin D. Biochemistry results were as follows: calcium, 16 different ranges from 8.0 mg/dL to 11.5 mg/dL; phosphorus, 13 different ranges from 2.5 mg/dL to 6.5 mg/dL; calcium-phosphorus product, 13 different ranges from 55-75; iPTH, 20 different ranges from 50-300 pg/mL; alkaline phosphatase, 18 different ranges from no records being monitored to a level of 500 mg/dL.
  
  
  CONCLUSIONS
  The survey revealed a large variability in the treatment of bone mineral metabolism. Improved clinical practice guidelines for the health care team are being developed with the National Kidney Foundation (NKF)-Kidney Disease Outcomes and Quality Initiative (KDOQI) bone disease management workgroup.
authors.affiliation: Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN 37232, USA.
authors.forename: Cathi J
authors.initials: CJ
authors.lastname: Martin
authors.forename: Susan M
authors.initials: SM
authors.lastname: Reams
mesh_terms: D000085:Acetates / Q000008:administration & dosage; D001842:Bone and Bones / Q000378:metabolism; D002119:Calcium Carbonate / Q000008:administration & dosage; D017610:Calcium Compounds; D004046:Dietetics; D004852:Epoxy Compounds / Q000008:administration & dosage; D004872:Ergocalciferols / Q000008:administration & dosage; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000517:prevention & control*; D007674:Kidney Diseases / Q000178:diet therapy*; D010710:Phosphates / Q000097:blood*; D016226:Phosphorus, Dietary / Q000008:administration & dosage; D011073:Polyamines; D011095:Polyethylenes / Q000008:administration & dosage; D006435:Renal Dialysis; D000069603:Sevelamer; D011795:Surveys and Questionnaires; D014807:Vitamin D / Q000008:administration & dosage
chemical_list: D000085:Acetates; D017610:Calcium Compounds; D004852:Epoxy Compounds; D004872:Ergocalciferols; D010710:Phosphates; D016226:Phosphorus, Dietary; D011073:Polyamines; D011095:Polyethylenes; D014807:Vitamin D; C084656:paricalcitol; D000069603:Sevelamer; D002119:Calcium Carbonate; C120662:calcium acetate