NATIONAL-KIDNEY-FOUNDATION - DIALYSIS OUTCOME QUALITY INITIATIVE - DEVELOPMENT OF METHODOLOGY FOR CLINICAL-PRACTICE GUIDELINES

Background. The NKF-DOQI(TM) (National Kidney Foundation - Dialysis Ou tcomes Quality Initiative) began in March 1995 with the following obje ctives: To improve end-stage renal disease (ESRF) patient survival, to reduce patient morbidity, to increase efficiency of care, and to impr ove quality of life for ESRF patients. Methods. The development of the NKF-DOQI Clinical Practice Guidelines focused on haemodialysis adequa cy, peritoneal dialysis adequacy, vascular access, and anaemia. Princi ples guiding the methodology included scientific and methodological ri gour, interdisciplinary approach, independence of the Work Groups, and an open review process. Unique features of this evidence-based guidel ine development process included the use of mock guidelines and ration ales to guide the literature research, and an unprecedented three-stag e review process. Results. Work Groups reviewed more than 11000 articl es. A total of 114 clinical practice guidelines were developed by the Work Groups; these have been reviewed by more than 1200 professionals and patients. Conclusion, The NKF-DOQI Clinical Practice Guidelines ha s been a unifying effort for the entire renal community. The guideline s are an important step in the process of improving the quality of dia lysis practice and improving ESRF patient outcomes. Priorities for imp lementation of the guidelines include education of ESRF professionals and patients, working with providers and insurers to encourage complia nce, and follow-up evaluation of patient outcomes to quantify complian ce results.