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Nephrol Dial Transplant (2000) 15: 1394-1398
© 2000 European Renal Association-European Dialysis and Transplant Association

Evaluation of clinical guidelines for the management of end-stage renal disease in Europe: the EU BIOMED 1 Study

Editor's note

Craig R. Ramsay1,, Marion K. Campbell1, Diego Cantarovich3, Graeme Catto2, June Cody2, Conal Daly2, Catherine Delcroix3, Neil Edward2, Jeremy M. Grimshaw1, Henk W. van Hamersvelt5, Ian S. Henderson4, Izhar H. Khan2, Robert A. P. Koene5, Mitsokoulis Papadimitrou6, Eberhard Ritz7, Dimitri Tsakiris6 and Alison M. MacLeod2

1 Health Services Research Unit, Aberdeen, 2 Department of Medicine and Therapeutics and Renal Unit, Aberdeen, UK, 3 University of Nantes, Nantes, France, 4 Renal Unit, Ninewells Hospital, Dundee, UK, 5 Department of Nephrology, Academic Hospital, Nijmegen, The Netherlands, 6 Aristolelian University of Thessaloniki, Thessaloniki, Greece and 7 University of Heidelberg, Heidelberg, Germany

Background. There are wide national and international variations in the management of patients with end-stage renal disease (ESRD). The aim of this study was to develop, harmonize, implement, and evaluate consensus-based clinical guidelines for the management of renal anaemia and renal bone disease in patients with ESRD, and for the prevention and management of cytomegalovirus disease in renal transplant recipients across six renal centres in Europe.

Methods. The trial was a prospective, multicentre, randomized balanced incomplete block design. Nephrologists from the six European renal units were randomized to develop and implement guidelines for two out of the three conditions and to act as a control for the third condition. Data were collected pre- (1 year) and post- (9 months) intervention on aspects of patient monitoring, management, and outcome.

Results. Eight hundred and twenty-nine dialysis patients from the six European dialysis centres were included in the study. Multivariate analysis (adjusting for case-mix and secular trends) showed a significant increase in the number of monitoring events in the guideline group compared with control group (6%, 95% CI, 1–11%). There was no concomitant increase in either appropriate management or the number of favourable patient outcomes.

Conclusions. In the first European collaboration on renal guidelines, the introduction of the guidelines improved the monitoring of the patients, but did not improve patient management or outcome. This study suggests the potential for creating clinical guidelines with the aim of standardizing treatment protocols across international boundaries, and improving the quality of the medical care provided.

Keywords: CAPD; clinical guidelines; cluster randomized trial; European guidelines; haemodialysis

Please see also Editorial Comment by F. Locatelli et al., pp. 1284–1287.

Correspondence and offprint requests to: Craig R. Ramsay, Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK.


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F. Locatelli, S. Andrulli, and L. Del Vecchio
Difficulties of implementing clinical guidelines in medical practice
Nephrol. Dial. Transplant., September 1, 2000; 15(9): 1284 - 1287.
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