Guidelines, Position Statements and ERBP: Survey Results

by Carmine Zoccali and Raymond Vanholder

817, i.e.  about 10 % of the NDT-E readership took the Clinical Guidelines Poll.

60% of participants were 45-65 year-old nephrologists,

56% of whom actively involved in  clinical nephrology.

One third of respondents worked in academic centres. Thus our sample represents middle-aged, motivated nephrologists with an over-representation of university-based individuals.

62% of respondents  believe that only some of the recommendations included in the main speciality guidelines (KDIGO and EBPG) should be considered as compulsory, which is in line  with the grading systems adopted in these guidelines. However, 1/3 of our sample considers all recommendations in guidelines as compulsory, which is in contrast with the weak evidence behind some recommendations. Finally 5% of respondents declared that they are simply confused with Guidelines recommendations.

This poll, like all polls we carry out in NDT-e, reflects the perceptions of the most motivated European nephrologists and therefore, cannot be considered as representative of the nephrology population at large.
This consideration and the sizeable proportion of respondents that either trust guideline recommendations independently of the level of the underlying scientific evidence or that are confused with guidelines, support the recent resolutions of the ERA-EDTA European Best Practice (ERBP) Advisory Board.  This Advisory Board decided to label as Guidelines only documents based on high level studies (well-performed meta-analyses or randomized  clinical trials) and to name as  "ERA-EDTA Position statements" all documents  based on moderate or weak scientific evidence. This  separation  may help nephrologists searching guidance in clinical practice to make a  clear distinction between compulsory recommendations and  simple  advice proposed by experts. Experts  may be  wrong and their advice in no way should dictate obligatory clinical decisions by the clinician.