There is ongoing controversy concerning the influence of the pharmaceutical industry on physicians, research publications, medical societies, and disease advocacy groups (1–7). Nowhere is the potential influence of industry more concerning than in development of clinical practice guidelines (8), which are designed to improve and standardize patient care yet also have enormous economic implications. As outlined herein, industry has provided major financial support to the National Kidney Foundation (NKF), the principal organization that develops and promulgates management guidelines in nephrology, and honoraria and/or research support to many participants who are involved in nephrology guideline development. Opinion-based recommendations have benefited some industries and harmed others. If not managed appropriately, then these relationships have the opportunity to undermine the guidelines and harm industry’s reputation. They also may reflect poorly on the renal community in general and threaten our independence. Major changes are necessary to limit the influence of conflicts of interest and the appearance of undue influence. The recent 2006 Kidney and Dialysis Outcomes Quality Initiative (KDOQI) anemia guidelines highlight many of these issues.
The New Hemoglobin Target
The recent 2006 KDOQI anemia guidelines increased the target hemoglobin range from 11 to 12 to 11 to 13 g/dl for all patients with chronic kidney disease (CKD) (9). Because of the tight relationship in patients with CKD between target hemoglobin and erythropoietin-stimulating protein (ESP; epoetin or darbepoetin) dosage (Figure 1), this undoubtedly will increase ESP use and cost to the health care system.
US hemodialysis prevalent patient mean weekly epoetin dosage (dashed line) and hemoglobin (solid line) from 1993 to 2004. Rate of deaths per 1000 patient-years (–•–) in prevalent US hemodialysis patients, adjusted for age, gender, race, and primary renal disease. Adapted from reference (10), pp 16, 26.
Since 1991, the mean hemoglobin and mean epoetin dosage in dialysis patients have risen steadily. Medicare’s …
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- ESRD Databases, Public Policy, and Quality of Care: Translational Medicine and Nephrology
- The Need to Systematically Evaluate Clinical Practice Guidelines
- Suggestions for improving guideline utility and trustworthiness
- Standardized Clinical Assessment And Management Plans (SCAMPs) Provide A Better Alternative To Clinical Practice Guidelines
- Funding for Medical Education: Maintaining a Healthy Separation From Industry
- Invited Article: Conflicts of interest for authors of American Academy of Neurology clinical practice guidelines
- Battleground: Chronic Kidney Disorders Mineral and Bone Disease Calcium Obsession, Vitamin D, and Binder Confusion
- Value of Quality Improvement Reporting