Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease: An Overview

George R. Bailie, PharmD, PhD, FCCP; Shaul G. Massry, MD


Pharmacotherapy. 2005;25(12):1687-1707. 

In This Article


The clinical practice guidelines discussed here are of particular relevance to the practice of pharmacy. With the increasing recognition that the number of patients with early stages of kidney disease is large, underdetection of these patients until the disease has progressed to its later stages is an ongoing problem, and the complications of CKD start early in the process, it behooves pharmacists to be completely familiar with the entire spectrum of CKD and its management. Of all the many complications of CKD, the problems associated with derangements in bone metabolism are perhaps the most complex and require a thorough understanding of the disease process such that appropriate drug therapy interventions can be made. New agents and new data continue to add to our comprehension of the process, but that in turn requires that we maintain a familiarity with the subject.

We reviewed only those clinical practice guidelines that we deemed to be of most significance to pharmacists. As such, many of the remaining guidelines may be of particular relevance to some, and readers are encouraged to scan the original K/DOQI guidelines to become familiar with their content. Pharmacists can play a more active role in the management of this and other complications of CKD. Many pharmacists practice in settings where they have no or limited access to laboratory monitoring parameters. There is little to prevent pharmacists in all settings from developing screening programs to detect patients at early stages of kidney disease and from working with local providers to ensure early follow-up. Further, pharmacists can provide continued patient counseling regarding adherence to diet and drug therapies, with a particular emphasis on ensuring that phosphorus binders be taken during meals and discussing the appropriate use of over-the-counter calcium supplements and the potential risk of gastrointestinal chelation interactions between phosphorus binders and concomitant drugs. Taken together with other initiatives previously discussed, such as monitoring of GFR for routine reports of kidney function, many possibilities exist for pharmacists to become active and vital contributors to the maintenance of health of the general population and to be recognized for these contributions.