Evaluation of clinical guidelines for the management of end stage renal disease in Europe: the EU BIOMED 1 study

Article type
Authors
Ramsay CR, Campbell MK, Cantarovich D, Catto G, Cody J, Daly C, Delcroix C, Edward N, Grimshaw JM, van Hamersvelt H, Henderson IS, Khan IH, Koene R, Papadimitrou M, Tsakiris D, Ritz E, MacLeod A
Abstract
Introduction/Objective: To develop, harmonise, implement, and evaluate consensus based clinical guidelines for the management of anaemia, bone disease and cytomegalovirus in patients with end stage renal disease across Europe.

Methods: Prospective, multicentre, randomised balanced incomplete block design. Nephrologists from 6 European renal units were randomised to develop and implement guidelines for two out of the three conditions and to act as a control for the third condition. Each centre acting as both a control and active site. Data were collected pre (1 year) and post (9 months) intervention on patient monitoring, patient management and patient outcome.

Results: 829 dialysis patients were recruited. Generalised linear modelling techniques (adjusting for case-mix, secular trends) showed a significant increase in the number of monitoring events in the intervention group compared with control group (0.16, 95% CI 0.024 to 0.303). This increase was consistent across all of the conditions.

Discussion: In the first European collaboration on renal guidelines, the introduction of the guidelines have improved the monitoring of the patients. Further detailed analysis is required to assess the impact of the guidelines on patient outcome and treatment.