NKF K/DOQI GUIDELINES 2000
GUIDELINES FOR PERITONEAL DIALYSIS ADEQUACY
II. NKF-K/DOQI CLINICAL PRACTICE GUIDELINES FOR PERITONEAL DIALYSIS ADEQUACY: UPDATE 2000
NOTE: The citation for these guidelines should read as follows: National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Peritoneal Dialysis Adequacy, 2000. Am J Kidney Dis 37:S65-S136, 2001 (suppl 1)
THIS WORK GROUP was charged with preparing practice guidelines for the "adequacy of peritoneal dialysis," a topic that could be defined broadly or narrowly. The Work Group elected to focus its guidelines on those areas of "adequacy" that needed the most urgent development, knowing that subsequent guidelines will be developed or that others were currently under development (eg, for management of peritonitis). In addition, the Work Group focused on topics for which guidelines would likely have the greatest impact on patient outcomes. However, the Work Groups focus should not be construed to mean that areas not covered are unimportant.
Some external reviewers criticized these guidelines as too complex, while others wrote that they were not thorough enough. Some wanted guidelines merged, and others thought the guidelines were too dense. The Work Group considered all these issues.
We advise the reader to first become familiar with the Table of Contents, which provides a listing of the Clinical Practice Guidelines for Peritoneal Dialysis Adequacy; detailed rationales are provided for each guideline. Redundancies are often intentional because it is anticipated that a reader might review only selected topics. However, the Work Group considers these guidelines as best viewed in their entirety, rather than in their component parts.
There is a paucity of data on children in the areas covered by these guidelines. Pediatricians were represented on the Work Group, and outside pediatric consultations were obtained. Because some recommendations for adults do not apply to children, additional recommendations are included when appropriate for pediatric patients. For the purpose of these guidelines, a child was considered to be a patient less than 19 years of age.
An "effective dose" is that which achieves its stated goal. That goal is some form of outcome measure(s), and could be determined by patient, provider, payer, regulator or a combination of these parties. At the lower extreme is the "minimal effective dose." In certain circumstances this may be interpreted as "adequate." At the other extreme is the "maximal effective dose," the dose above which there are no additional benefits. For hemodialysis and peritoneal dialysis the maximal effective dose is not known. Somewhere between these extremes is the "optimal dose," the dose above which the additional derived benefit does not justify the additional cost or burden. If one accepts this definition, the Work Group intended to more precisely define "optimal dose" targets in a clinically relevant and quantitative fashion. It was the intention of the Work Group to bring "adequate dose" to the level of "optimal dose" by raising the outcome goals or expectations. The present guidelines attempt to make recommendations based on available scientific/medical evidence, resorting to expert opinion only when necessary. It is clearly stated in each guideline title when recommendations were based on evidence, opinion, or both. Even when guidelines were based on opinion, that opinion is supported by direct or extrapolated evidence.
These guidelines are intended for use by health care professionals trained to understand variations in the practice of medicine and the necessity for such variation. These guidelines are not intended for punitive use by any oversight official who does not understand the reasons or the necessity for practice variations including variations in societies different from that of the United States.
© 2001 by the National Kidney Foundation, Inc.
© 2001 National Kidney Foundation, Inc