Futuristic plans for ESRD--a new bundled payment system.
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Biomedical subjects
Publications and source records attributed to Maureen Michael.
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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.
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.