Bone metabolism and disease--K/DOQI impact on nurses and dietitians.

Earlier monitoring and treatment of elevated phosphorus and PTH prior to initiation of dialysis may prevent the development of bone disease. We can no longer be complacent or content with patients having a calcium-phosphorus product of 70 or phosphorus of 6.0. When we strive for the recommended optimal levels and goals and work toward these new goals we will improve our patient outcomes. We must be vigilant and have an increased intensity of focus on bone metabolism as part of the total patient care. The entire team serves to provide ongoing education and encouragement throughout the continuum of care with the CKD client.