The Dialysis Outcomes Quality Initiative Guidelines: A New Standard for Everybody?

Correspondence to: J. Burkart, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston–Salem, North Carolina 27157-1053 U.S.A. In 1997, the Dialysis Outcomes Quality Initiative (DOQI) clinical practice guidelines initiated by the National Kidney Foundation (NKF) of the United States were published (1). These practice guidelines covered broad areas of care (anemia, vascular access, adequacy of dialysis, and—soon to be published— nutrition) for the patient with end-stage renal disease (ESRD). The guidelines were formulated on evidence-based principles; but, often, where sufficient evidence was lacking, the consensus of expert opinion was accepted. Before publication, the guidelines underwent a series of intense peer reviews and modifications. Soon after publication, questions arose (2). Are the guidelines on target? Do they need further development and modification? Are they for everybody? This paper discusses potential answers to those questions.