NDIVIDUALS WITH MODERATE TOsevere renal disease have an impaired ability to excrete phosphorus. As a result, they tend to develop hyperphosphatemia, especially in settings of high phosphorus intake. Elevated serum phosphorus levels are independently associated with increased mortality and morbidity. For example, serum phosphorus levels greater than the 5.5-mg/dL level recommended by practice guidelines are independently associated with a 20% to 40% increase in mortality risk among patients with end-stage renal disease (ESRD). [1][2][3][4][5][6][7][8][9] In addition, hyperphosphatemia appears to be involved in the development of atherosclerotic heart disease, secondary hyperparathyroidism, and bone disease among renal patients. [10][11][12] High phosphorus intake may also be detrimental for the general public. The dietary phosphorus intake of individuals in the United States has been in-creasing, while intake of calcium has been decreasing. 13 There is evidence to suggest that these intake patterns in-terfere with the normal process of calcium regulation and affect both peak bone mass and rate of bone loss, even See also Patient Page.

SummaryBackground and objectives Many patients with ESRD, particularly minorities and women, face barriers in completing the steps required to obtain a transplant. These eight sequential steps are as follows: medical suitability, interest in transplant, referral to a transplant center, first visit to center, transplant workup, successful candidate, waiting list or identify living donor, and receive transplant. This study sought to determine the effect of navigators on completion of steps.