Ottawa Hospital Ontario Canada Email: dzimmerman{at}ottawahospital.on.ca
Sir,
I would like to acknowledge the insightful comments of Ghosh with regards to our study of primary care in dialysis patients. While I agree with many of the comments, I believe a couple of issues require further elaboration. I think some of the inertia in the treatment of dialysis patients stems from the lack of evidence to support applying the same guidelines of care to our patient population as the general population. Perhaps the area where this has been explored the most is in the cancer screening literature, but also extends to other therapies such as ASA for stroke prevention. The risk/benefit ratio may be very different in the dialysis population. This lack of evidence inhibits the development of guidelines that are more than just expert opinion. This issue will be highlighted in the next DOQI guidelines on the management of cardiovascular disease in patients with end-stage renal disease. We need well-designed studies to address our lack of evidence in order to improve the overall care of patients with kidney failure.
Conflict of interest statement. None declared.