NDT Advance Access originally published online on January 17, 2008
Nephrology Dialysis Transplantation 2008 23(5):1772; doi:10.1093/ndt/gfm922
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Reply
Correspondence and offprint requests to: E-mail: iain.macdougall{at}kch.nhs.ukSir,
We are writing in response to Dr Shaldon's remarks on our recent Editorial Comment [1]. Unfortunately, Dr Shaldon detracts from the main focus of this article that was questioning whether a new set of guidelines should be developed in Europe following the publication of the KDOQI Anaemia Guidelines, and our personal recommendation was that this was unnecessary; this recommendation was recently reiterated by an international group of guideline experts who recommended that the next set of anaemia guidelines should be developed by KDIGO once significant new data are available. The efforts of KDIGO to coordinate guideline development will promote better use of resources, and stop the fruitless repetition of guidelines that has long been supported and fostered by industry.
The KDOQI guidelines reflect a huge effort to interpret the available evidence in the best possible and objective way, including external review. Although Dr Shaldon may disagree with the conclusions of the Anaemia Work Group, we would advise him to carefully read these guidelines. There he will find an in-depth discussion of the risks and benefits of ESA therapy, including the effects on health-related quality-of-life, the methodology available to measure this parameter, as well as a discussion on the limitations of current trials. When he studies this document carefully, he will also notice that there is no evidence that ‘over-swings’ of haemoglobin levels in patients treated to the recommended targets put them at increased risk. Dr Shaldon may also be aware of the recent post hoc analysis of the CHOIR study that showed no risks in patients who actually reached their haemoglobin target, with the extra risk only evident for those patients who did not reach the target and who received high doses of epoetin.
Finally, Dr Shaldon alludes to the current hot topic of guideline development in groups of individuals who have potential conflicts of interest. This subject was intensely debated in the ‘Controversies in Nephrology’ section of the January 2007 issue of CJASN, and will therefore not be further elaborated here. Suffice to say that we agree with the reasons propagated by Dr Van Wyck and colleagues [2] why it is unrealistic to propose that guideline development be carried out only by ‘intelligent physician-scientists with no conflict of interest’. Most importantly in this context, there should be full disclosure of all authors or participants in this process. This also applies to the authorship of the current article, which Dr Shaldon has clearly taken great pleasure in criticising.
Conflict of interest statement: All authors have received consulting fees, honoraria, and lecture fees from Amgen, Ortho Biotech, Roche, Shire, and Affymax.
Renal Unit, King's College Hospital, London, UK
References
- Macdougall IC, Eckardt K-U, Locatelli F. Latest US KDOQI Anaemia Guidelines update—what are the implications for Europe? Nephrol Dial Transplant (2007) 22:2738–2742.
[Free Full Text] - Van Wyck D, Eckardt K-U, Uhlig K, et al. Response to "Influence of Industry on Renal Guideline Development". Clin J Am Soc Nephrol (2007) 2:13–14.
[Free Full Text]
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In his letter, Dr Shaldon also expressed his surprise about the ‘rapid acceptance’ of the Editorial Comment by Macdougall et al. In fact, we received the Editorial Comment at the Editorial Office on 7 April 2007. After external review, the paper was accepted on 31 May 2007. The ‘received for publication’ date mentioned on the published paper (22 July 2007) was the date on which the manuscript was uploaded via the NDT website. It took the ‘sharp eye’ of Dr Shaldon to detect this mistake in dates.Norbert LameireEditor-in-Chief NDTNorbert.lameire@ugent.be
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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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