title: Multidisciplinary approach for prescriptive management of mineral and bone metabolism in chronic kidney disease: development of a dietetic led protocol.
abstract: BACKGROUND
  A number of mineral metabolism abnormalities occur as kidney function declines, these include hyperphosphatemia, hyperparathyroidism and altered vitamin D metabolism. These derangements are associated with increased morbidity and mortality amongst the chronic kidney disease patient group. Treatment requires a multidisciplinary team approach in which the dietitian plays a pivotal role.
  
  
  OBJECTIVE
  The development of protocols to aid implementation of various international, national and local treatment strategies is described. Audit the protocol to evaluate their clinical effectiveness.
  
  
  RESULTS
  A prescriptive Protocol for the management of mineral and bone metabolism abnormalities in chronic kidney disease was developed and implemented. Initial audit findings suggest the protocol has had a positive effect on the control of phosphate, corrected calcium and parathyroid (PTH) levels.
  
  
  CONCLUSIONS
  The development and implementation of a dietetic-led prescriptive therapy protocol allows dietitians and clinicians to adopt an integrated approach for the diagnosis and timely management of these complicated conditions.
authors.affiliation: Arrowe Park Hospital, Upton, Wirral, UK. jonathan.casey@whnt.nhs.uk
authors.forename: Jonathan
authors.initials: J
authors.lastname: Casey
authors.forename: Chui Han
authors.initials: CH
authors.lastname: Li
authors.forename: V
authors.initials: V
authors.lastname: Johnsson
authors.forename: C
authors.initials: C
authors.lastname: Sluman
authors.forename: P
authors.initials: P
authors.lastname: McClelland
mesh_terms: D000465:Algorithms; D000536:Aluminum Hydroxide / Q000627:therapeutic use; D019985:Benchmarking; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002985:Clinical Protocols / Q000592:standards*; D003663:Decision Trees; D004046:Dietetics / Q000458:organization & administration; D006801:Humans; D006887:Hydroxycholecalciferols / Q000627:therapeutic use; D006934:Hypercalcemia / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D006962:Hyperparathyroidism, Secondary / Q000178:diet therapy* / Q000209:etiology / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000150:complications*; D008485:Medical Audit; D010348:Patient Care Team / Q000458:organization & administration; D010760:Phosphorus Metabolism Disorders / Q000178:diet therapy* / Q000209:etiology / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D024382:Professional Role; D016896:Treatment Outcome; D014808:Vitamin D Deficiency / Q000178:diet therapy* / Q000209:etiology / Q000517:prevention & control
chemical_list: D050071:Bone Density Conservation Agents; D006887:Hydroxycholecalciferols; D000536:Aluminum Hydroxide; C008088:alfacalcidol