Evidence-based medicine and its horizons: a useful tool for nephrologists?

Though the concept of 'evidence-based medicine' (EBM) nowadays has become v ery popular and even fashionable, its practice is far from being an establi shed reality. There are many reasons why, despite its potential, EBM finds obstacles in expressing its full potential as a tool to better inform healt h care decisions. Broadly speaking, these obstacles fall into three categor ies: (i) inadequacy of available information with respect the complexities of health care delivery; (ii) poor quality of clinical research; and (iii) insufficient and inappropriate efforts to promote the uptake of effective i nterventions in clinical practice. In the first part of the paper, we will discuss: (i) what evidence-based medicine is; (ii) why systematic reviews a re the fundamental tool of EBM and what is really special about them; (iii) what are the tools for the practice of EBM; (iv) what its limitations are; and (v) what are the hindrances to its implementation. In the second part, a brief assessment of the state of the art of systematic reviews in nephro logy will be presented, with special reference to the activities of the rec ently launched Cochrane Collaborative Review Group in Renal Diseases.