Ask the Doctor
Questions about kidney disease? Risk factors? Signs and symptoms? Are you concerned about yourself, a friend or family member? Ask Dr. Spry.
New York, NY
February 22, 2001
The National Kidney Foundation (NKF) marked a milestone with the publication of its Kidney Disease Outcomes Quality Initiative (K/DOQI) Updates 2000 as a supplement to the American Journal of Kidney Diseases in January. A thorough review of new literature revealed very little evidence that warranted changes in the original guidelines, which cover hemodialysis adequacy, peritoneal dialysis adequacy, management of vascular access and management of anemia.
When the original NKF-DOQI guidelines were published in 1997, they represented the first comprehensive effort to give evidenced-based guidance to clinical care teams for the management of dialysis patients. Today, the guidelines have become an integral part of world-wide nephrology practice, having been translated into nearly a dozen languages.
“It was agreed from the beginning that the DOQI guidelines would be maintained as a living, evolving document, with periodic reviews of the literature and revisions,” says Garabed Eknoyan, MD, who has co-chaired the DOQI and K/DOQI efforts with Nathan Levin, MD. “Any set of guidelines begins to be outdated the moment it is published, as new data in the field become available,” he continues. This was the rationale behind the recently-released update, which included a structured analysis of 85 key scientific articles published since the original DOQI literature review ended in April 1996.
Changes to the original guidelines varied according to the topic. In the area of hemodialysis adequacy, there was no evidence to suggest the inclusion of new guidelines nor the deletion of any of the original guideline statements. Only one statement was modified.
No additions were made to the peritoneal dialysis guidelines, although there were two major changes involving nutritional indications for renal replacement therapy, and dialysis dose targets. In the area of vascular access, a limited number of significant changes were made to the guidelines, including stronger recommendations of transposed brachiobasilic vein fistulas and intra-access flow monitoring as preferred techniques. Management of anemia represented the largest body of additional evidence. Thirty-seven articles presented new data that either augmented or modified the original guidelines, particularly in the area of iron management.
“The K/DOQI 2000 Updates are a testament to the great work done by the original DOQI work groups. That few changes needed to be made proved the strength and solidness of the original work. There were very few fundamental changes,” Dr. Levin noted.
The update process was led by the chairs of the four original DOQI work groups: hemodialysis, William Owen, Jr., MD (chair), Jimmy Roberts, MD (vice-chair); peritoneal dialysis, Thomas Golper, MD (chair), David Churchill, MD (vice-chair); vascular access, Steve Schwab, MD (chair), Anatole Besarab, MD (vice-chair); anemia, Joseph Eshbach, MD (chair), Peter DeOreo, MD (vice-chair) and the methodologic support of Earl Steinberg, MD, MPH.
The guidelines were subjected to a three-stage review process. They were presented to the NKF-DOQI Steering Committee, followed by the K/DOQI Advisory Board, along with experts in the field and finally, the general public.
As with the original guidelines, Amgen was Founding and Principal Sponsor of the 2000 Updates.
The National Kidney Foundation is dedicated to preventing kidney and urinary tract diseases, improving the health and well-being of individuals and families affected by these diseases and increasing the availability of all organs for transplantation.