KDOQI US commentary on the KDIGO clinical practice guideline for the prevention, diagnosis, evaluation, and treatment of hepatitis C in CKD.

KDIGO (Kidney Disease: Improving Global Outcomes) is an international initiative with a key mission of developing clinical practice guidelines in the area of chronic kidney disease (CKD). KDIGO recently published evidence-based clinical practice guidelines for the prevention, diagnosis, evaluation, and treatment of hepatitis C virus infection in individuals with CKD. The process of adaptation of international guidelines is an important task that, although guided by general principles, needs to be individualized for each region and country. Therefore, the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (KDOQI) convened a multidisciplinary group to comment on the application and implementation of the KDIGO guidelines for patients with CKD in the United States. This commentary summarizes the process undertaken by this group in considering the guidelines in the context of health care delivery in the United States. Guideline statements are presented, followed by a succinct discussion and annotation of the rationale for the statements. Research recommendations that are of particular interest to the United States are then summarized to highlight future areas of inquiry that would enable updating of the guidelines.

Anemia management protocols: providing consistent hemoglobin outcomes.

Anemia management protocols encourage a consistent therapeutic approach that can increase the likelihood of patients achieving and maintaining stable hemoglobin levels within the target range of 17 to 12 g/dL recommended by the National Kidney Foundation. This article provides an overview of current concepts of anemia management that can be integrated into protocol development and refinement.

Secondary hyperparathyroidism in chronic kidney disease: clinical consequences and challenges.

Secondary hyperparathyroidism, a characteristic manifestation of chronic kidney disease (CKD), arises from a series of abnormalities in the interrelated cascade that controls bone and mineral metabolism. Although bone disease is the most recognized consequence of secondary hyperparathyroidism (HPT), it also precipitates a series of potentially devastating effects on the cardiovascular, nervous, endocrine, and erythropoietic systems. Optimal management of secondary hyperparathyroidism should allow control of serum parathyroid hormone levels while preventing hyperphosphatemia, maintaining normal calcium levels, and providing adequate vitamin D supplementation. Current therapeutic approaches are frequently unsuccessful in achieving these goals and may, in fact, exacerbate risk factors that increase morbidity and mortality in the dialysis population. Development of new therapeutic approaches may provide improved control of secondary hyperparathyroidism in the future.