NDT Advance Access originally published online on November 20, 2007
Nephrology Dialysis Transplantation 2008 23(1):56-61; doi:10.1093/ndt/gfm706
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Negative outcome studies in end-stage renal disease: how dark are the storm clouds?
1Nephrology Clinic, "Dr. C. I. Parhon" University Hospital, Iasi, Romania and 2Renal Unit, Guy's Hospital, London, UK
Correspondence and offprint requests to: Adrian Covic, Director, Dialysis and Transplantation Center and Nephrology Clinic, Parhon University Hospital, 50 Carol 1st Blvd., Iasi 700503, Romania. Tel: +40-232-211752; E-mail: acovic@xnet.ro
Keywords: chronic kidney disease; end-stage renal disease; haemodialysis; outcome; randomized controlled trials
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ESRD—the epidemiological challenge |
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The end-stage renal disease (ESRD) population treated by dialysis has grown remorselessly over the last five decades, in all continents. This growth is already a major burden to the healthcare economies of wealthy countries, and is thus a challenge for policy makers, health care providers and financial planners [1]. Fortunately, recent data (just published in NDT) suggest a stabilization/decline in the incidence of ESRD in some developed countries, possibly related to the successful implementation of renoprotective strategies in pre-dialysis chronic kidney disease (CKD) [2,3].
Dialysis patients have an impressive and worrying mortality, comparable to or worse than that seen in many cancers, e.g. 20–25% annualized mortality in some systems [4]. Around 50% of this increased mortality is due to cardiovascular (CV) disease. This is explicable, as at the start of dialysis, up to 80% of subjects already have at least subclinical CV
Dialysis dose and mortality
Targeting CV risk factors—the ‘disappointing statin issue’
Hypertension therapy in ESRD
Homocysteine—a missed target
Influencing mineral- metabolism parameters
The anaemia story in CKD—a lost opportunity
Some hope beyond dark clouds?
The multiple bullet approach—can it work for dialysis patients?
How do we deal with (negative) randomized controlled trials?
What should we do next?
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