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Perit Dial Int 27(Supplement_3): 11- 2007
© 2007 International Society for Peritoneal Dialysis
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Calcium, Phosphorus, PTH

Oral Doxercalciferol Protocol Implementation with Registered Nurse Management Results in Improved iPTH and Phosphorus Outcomes in a Stage 5 CKD Peritoneal Dialysis Population

M. Caviness and R. Camper

DaVita Inc., Visalia, California, USA

Objective: The bone mineral metabolism (BMM) outcomes in this patient population lead to consensus to change from physician management of BMM to the implementation of a physician-approved oral doxercalciferol protocol and comprehensive nurse management. The primary focus of this project was phosphorus and intact parathyroid hormone (iPTH) levels.

Methods: The process involved development of the protocol using defined parameters for iPTH, cCa, P04, and cCaxP04 product and consultant recommendations for initiation and titration dosing with exclusive use of the 2.5 µg doxercalciferol capsules.

Results: The peritoneal dialysis (PD) nurses instituted the protocol as of July 2006 with conversion dosing and/or titration dosing. Titration dosing per protocol continued on a monthly basis. Results of protocol implementation, education, and titration are as follows: iPTH 150–300 pg/mL in July 2006 25% by the end of Oct 2006 was 55.6%, PO4 ≤5.5 in July 2006 62.1% by the end of Oct 2006 was 84.6%.

Conclusions: To summarize, there was a 37% improvement in iPTH in target range from Q1 to Q3 and 11% improvement of patients in P04 target range, 65.6% Q-1 versus 73% Q-3. Also, there was a 48% improvement in P04 >6 mg/dL from Q1 to Q3. October results demonstrate continued improvement in parameters measured. In this PD patient population the implementation and utilization of an oral doxercalciferol protocol resulted in dramatically improved P04 and iPTH outcomes.






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