NDT Advance Access originally published online on January 10, 2008
Nephrology Dialysis Transplantation 2008 23(5):1771; doi:10.1093/ndt/gfm920
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Conflict of interest in clinical guidelines should be avoided
Correspondence and offprint requests to: E-mail: shaldon{at}libello.comSir,
Responding to your request to generate a lively discussion on the nuantial Editorial Comment on the latest US KDOQI Anaemia Guidelines update [1], I will attempt to be extremely critical of several of the comments made by the authors. Firstly, allow me to state that their conflict of interest declarations show all three of them to be heavily involved with the EPO companies. The comment would have had far more credibility had your editorial policy followed recommendations published in the Lancet in 2006 by Richard Steinbrook, in which he stated that ‘Given the billions of dollars at stake for the drug and dialysis industries, such guidance is likely to receive the broadest acceptance if developed without industry support, and by experts without relevant financial associations’ [2]. The extremely rapid acceptance of the comment (1 day after reception) suggests that the authors’ position in this ongoing debate was already accepted prior to reception. Their strident criticism of current guidelines invoked by Strippoli et al. in the Lancet [3], in which the authors had no conflict of interest, confirms my suspicions that their commentary must be viewed more critically.
Their pleas to reconsider quality of life data are scientifically unacceptable, as to date there is no evidence that meets the minimal requirements of objectively collected data. Similarly, the levels of haemoglobin stated are given without scientific evidence of benefit and the overswings undoubtedly put the patients at risk. The argument that one can avoid blood transfusions is not relevant, as clearly it has been possible to maintain patients on haemodialysis indefinitely without blood transfusions [4,5], before the availability of EPO and with no apparent detriment to their survival. Indeed, the world renowned centre at Tassin, La Demi-Lune, has for many years published the best survival data on dialysis in the world with the least consumption of erythropoietin [6].
Conflict of interest statement. None declared.
Fontvieille, Monaco
References
- Macdougal IC, Eckardt KU, Locatelli F. Latest US KDOQI Anaemia Guidelines update—what are the implications for Europe? Nephrol Dial Transplant (2007) 22:2738–2742.
[Free Full Text] - Steinbrook R. Haemoglobin concentrations in chronic kidney disease. Lancet (2006) 368:2191–2193.[CrossRef][Web of Science][Medline]
- Strippoli GFM, Tognoni G, Navaneethan SD. Haemoglobin targets: we were wrong, time to move on. Lancet (2007) 369:346–350.[CrossRef][Web of Science][Medline]
- Shaldon S. Chronic dialysis without transfusion. Lancet (1967) 2:783.[Web of Science][Medline]
- Crockett RE, Baillod RA, Lee BN, et al. Maintenance of 50 patients on intermittent haemodialysis without blood transfusion. Proc Eur Dial Transplant Assoc (1967) 4:17–27.[Medline]
- Charra B, Calemard E, Ruffet M, et al. Survival as an index of adequacy of dialysis. Kidney Int (1992) 41:1286–1291.[Web of Science][Medline]
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  D. W. Coyne Conflicts of interest and viewpoint bias in KDOQI and KDIGO workgroups Nephrol. Dial. Transplant., December 1, 2008; 23(12): 4071 - 4071. [Full Text] [PDF]
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I. C. Macdougall, K.-U. Eckardt, and F. Locatelli Reply Nephrol. Dial. Transplant., December 1, 2008; 23(12): 4071 - 4072. [Full Text] [PDF]
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