Dialysis outcome quality initiative (DOQI) guideline for hemodialysis adequacy

The article about Dialysis Outcome Quality Initiative (DOQI), recently publ ished by the National Kidney Foundation in The American Journal of Kidney D isease provides clear guidelines for adequacy of hemodialysis, peritoneal d ialysis, vascular access and treatment of anemia in End-Stage Renal Disease (ESRD). If the dissemination of these guidelines actually increases Kt/V, an early improvement of the outcome of dialysis patients will be expected b ecause there is a close correlation between dialysis dose and mortality. Mo rtality, unless high, is the main indicator of the efficacy of guidelines i n ESRD. Other indicators are needed to assess the effects of the modificati on in clinical practice induced by DOQI at lower mortality, as in other wes tern European countries. Quality of life adjusted for life expectancy defin ed Kt/V of 1.3 as the optimal cost-effective dialysis dose; large evidence is missing to support the use of higher doses or of high technology in hemo dialysis treatment. Adequacy and uniformity of isolated hemodialysis proced ures are accurately defined by DOQI. Quality assessment of integrated actio ns in overall commitment of ESRD patients (prevention and treatment of co-m orbidity of uremia, renal transplantation programs, improvement of the comm unication with caregivers and family, enhanced fitness and ability to work) has still to be implemented with recommendations and indicators of the out come. NKF-DOQI defined only dialysis adequacy; further work is necessary to assess the "optimal clinical practice" for ESRD patients.