Based on these requirements attention was put on a protocol following the idea of implementation of uniform and solid standards of care, as suggested by the workgroups of the European Best Practice Guideline initiative. A protocol was generated combining ideas and suggestions of the Toledo Quest work groups.

Currently QUEST members favour the PRIMA study (Protocol Intensified Multifactorial Approach) which is going to test the hypothesis that a structural higher level of care may increase survival in a relatively short period of time (3 years) in patients on dialysis therapy.

The primary aim of the study is to assess the effects of “treatment by protocol” versus “standard treatment” on the time of death, due to all-causes, in more than 6000 men or women, of all age groups, on maintenance haemodialysis treatment for less than 12 months all-over Europe. Currently the protocol is under review of clinical trialists but clinical action plans (treatment by protocol) still require refinement. It is anticipated that the protocol can be distributed at the ERA-EDTA Glasgow Congress.