The dialysis outcomes quality initiative: History, impact, and prospects

Rigorously developed clinical practice guidelines have the potential to imp rove patient outcomes. It is toward that end that the National Kidney Found ation (NKF) launched in March 1995 the Dialysis Outcome Quality Initiative (DOQI), an ambitious effort to develop evidence-based clinical practice gui delines for the care of patients with end-stage renal disease (ESRD), Indep endent, interdisciplinary work groups conducted a structured review of the content and methodologic rigor of all the published literature pertinent to four selected topics: hemodialysis adequacy, peritoneal dialysis adequacy, vascular access, and anemia, Following expert, organizational, and public review, the guidelines were issued in September and October 1997, An implem entation plan that called for widespread dissemination of the guidelines an d facilitation of adoption of them has resulted in their broad acceptance a nd integration into quality improvement efforts. Additional guidelines on n utrition have recently been completed, while others on bone disease, hypert ension, and hyperlipidemia are in various stages of planning or development . A major determinant of poor outcome of maintenance dialysis patients is t he debilitated state of many individuals with ESRD at the time that they co mmence dialysis therapy. The recognition of this problem has stimulated an interest in extending the guidelines to management of patients with less se vere renal insufficiency, well before they need renal replacement therapy; and to the early detection of renal insufficiency by a proteinuria and albu minuria risk assessment, detection, and elimination (PARADE) program. What started as an initiative to improve the quality of care of dialysis patient s has evolved into a considerably expanded effort to making lives better fo r all individuals with any level of renal insufficiency. (C) 2000 by the Na tional Kidney Foundation, Inc.