Why do we need outcomes research in end stage renal disease?

Despite effective therapeutic strategies to slow or arrest the progression of chronic renal diseases, the number of patients entering renal replacemen t programs is increasing, with a dramatic burden in terms of morbidity, mor tality and resource consumption. While in the past the attention was mainly devoted to the improvement of di alysis care, it has recently been argued that the timing and quality of car e before dialysis is started may significantly affect the prognosis. Proble ms of transfer of research results, together with differences in physicians ' attitudes and beliefs as well as in structural and organisational aspects make pre-end-stage renal disease (ESRD) care extremely heterogeneous. This : lack of uniformity in medical practice has stimulated extensive inquiry i nto the relation between the use of clinical services and their end results - the outcomes. Outcomes research investigates medical effectiveness, meaning how well prev ailing treatments work in different clinical practice settings. It is thus an important tool to help patients, providers and purchasers to make sound decisions, based on a deeper knowledge of how different choices affect the patient's life. By using a broad array of outcome measures, this research s erves to evaluate the effectiveness of complex health care strategies from the different points of view of patients, providers and purchasers, reconci ling their needs. Starting from these premises, initiatives aimed to evaluate the avoidabilit y of ESRD morbidity and mortality are urgently needed. To this purpose, the care delivered to ESRD patients and its impact on clinical variables, qual ity of life and resource consumption need to be longitudinally monitored. O utcomes research thus represents a unique opportunity to increase our knowl edge on pre-ESRD care and to identify those strategies more likely to reduc e the unwanted outcomes related to the initiation of dialytic treatment.