The sole reference made to anterior chest wall grafts in any current literature was found in the NKF-DOQI
guidelines (NKF, 2000).
clinical practice guidelines are an excellent reference on certain expectations of care for dialysis patients, as it provides both process and outcome benchmarks.
Thus, it seems prudent to continue to strive for the standard recommended by NKF-DOQI
(1997) of fewer than 10% of hemodialysis patients with CV catheters.
describes CPGs for this process of patient care.
National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI
) Clinical Practice Guidelines for Hemodialysis Adequacy.
The discussion in the original guidelines (NKF-DOQI
Peritoneal Dialysis Adequacy Work Group, 1997) stated that "theoretical constructs suggest that the minimum weekly Kt/[V.sub.urea] should be 2.0" and that "cohort studies using univariate statistical analysis support this `target.'" In contrast, the rationale stated that "there are no theoretical data to support a specific [C.sub.cr] target." The 60 L target was chosen because in the multicenter Italian study by Majorca et al.
Hemodialysis Adequacy CPM IV -- Method of Post-Dialysis Blood Urea Nitrogen (BUN) Sampling, which is based on NKF-DOQI
Hemodialysis Clinical Practice Guidelines No.
The 1997 Hemodialysis Adequacy Work Group of the NKF-DOQI
reviewed these initial recommendations and developed updates and supplements that provided strategies for their translation into clinical practice.
As suggested by the Anemia Work Group (NKF-DOQI
, 1997), the American Society of Nephrology (Hakim et al., 1998), and Besarb et al.
Current concepts of anemia management in chronic renal failure: impact of NKF-DOQI
. Seminars in Nephrology, 20, 320-329.
These clinical indicators suggest that NKF-DOQI
recommendations for successful anemia management in ESRD patients have not been fully achieved.
The original target Hct range of 30% to 36% (Hb of 10 to 12 g/dL) recommended in the Epoetin, alfa Package Insert (Amgen, 1999) was refined following a comprehensive review of the clinical literature conducted by the National Kidney Foundation's Dialysis Outcomes Quality Initiative (NKF-DOQI
) Anemia Workgroup (Figure 1).