Building the evidence in peritoneal dialysis: use of randomized controlled trials, and observational and registry data.
Renal replacement therapy (RRT) has achieved widespread acceptance without being subjected to the rigors of randomized controlled clinical trials (RCCTs). The RCCT remains the "gold standard" of evidenced-based medicine, but ethical, logistic, and financial limitations mean that not all questions are amenable to a RCCT. Renal registries collect, aggregate, analyze, and interpret data on the occurrence and outcome of renal failure in a defined population. Observational data can be used only to show associations, not causality. Nevertheless, most clinical practice guidelines in nephrology are derived from observational data. The nephrology community needs to join forces to decide the questions that deserve the time, energy, and resources of an RCCT. Prospective observational data can be enhanced by collaboration, standardized definitions, development of a risk-adjustment tool, and consensus among the key players, including professional associations, government, industry, and hospitals. The challenge is to provide evidence-based practice guidelines for the delivery of care to the end-stage renal patient.
Moist
L M
LM
Division of Nephrology, University of Western Ontario, London Health Sciences Centre, Canada. louise.moist@lhsc.on.ca
D019317:Evidence-Based Medicine; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D010530:Peritoneal Dialysis; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012042:Registries