Contributions as of July 1, 2007

Stage 4-5 CKD Registries: a challenge to take

Chronic kidney disease (CKD) is now recognized as a worldwide public health problem.
The KDOQI CKD staging system is a formidable instrument for deploying interventions calibrated to the various CKD stages and also a useful intellectual framework for stimulating well focused research on kidney diseases. Stage 4 (severe CKD) is a critical phase in this staging system because it is precisely at this phase that the renal team should prepare the patient and his family for kidney replacement therapy. Observational studies in various European countries indicate an increasing stage 4-CKD prevalence coupled with poor outcomes and concerning costs. Unfortunately, notwithstanding tantalising efforts by nephrologists for addressing attention of other doctors and health authorities to the risk posed by moderate and severe CKD, late referral still remains a problem in most countries. This is unfortunate because the adverse outcomes of kidney failure, cardiovascular
disease and the short life expectancy of CKD patients can be modified by available treatments and by streamlining their access to renal units. Many countries have registries for patients treated by dialysis and transplantation.

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In clinical epidemiology several study designs are applied to investigate relationships between an exposure (medical treatment, environmental factor, etc.) and an outcome (development of a disease, death, etc.). Randomized Controlled Trials (RCTs) on the one hand, and observational studies such as cohort and casecontrol studies on the other hand, are important study designs that are used in the field of nephrology research.
To study the effect of therapy or other interventions, the RCT is an almost unbeatable standard in research: the problems that may occur in the other study designs do not exist or to a lesser extent using an RCT.

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