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Titolo	European best practice guidelines for peritoneal dialysis acknowledged by ISN
Autore	O. Abboud, R. Barsoum, F. Betrthoux, M. Field, R. Johnson, S. Lin, P. Massari
Referenza	Nature Clinical Practice NEPHROLOGY 2007; 3 (1): 6-7
Contenuto	INTRODUCTION In 2005, the European Renal Association published the European Best Practice Guidelines (EBPG) for Peritoneal Dialysis.1 The document includes a preface explaining how the process was initiated and conducted, and the methodology used to reach the conclusions. The guidelines consist of nine sections: general aspects, initiation of dialysis, peritoneal access, continuous ambulatory peritoneal dialysis, peritoneal dialysis solutions, automated peritoneal dia lysis, adequacy of peritoneal dialysis, nutrition in peritoneal dialysis, and peritoneal dialysis and transplantation. These documents have been examined by the Clinical Practice Guidelines (CPG) Committee of the International Society of Nephrology (ISN). The review process included critical appraisal by two independent panels; the first of experts in methodology and medical statistics, the second of international authorities in clinical peritoneal dialysis. Both panels recommended that the ISN acknowledge these guidelines and recommend them for implementation by its members. The panels did, however, raise several important points regarding methodology and applicability in different parts of the world. There was general agreement that peritoneal dialysis facilities should have a well-articulated organizational structure, incorporating appropriate staff facilities, training and educational programs, and clear protocols to guide the actions of staff and patients. These protocols should be based on internationally recognized guidelines, but should be extended to include the absolute and relative indications and contraindications for peritoneal dialysis, as well as clear management plans in the event that peritoneal dialysis fails. It is essential that a peritoneal dia lysis program be supported by a back-up hemodialysis program and hospital facilities, and preferably by a renal transplantation program. Ideally, a peritoneal dialysis facility should also incorporate automated peritoneal dialysis, but this is not considered essential. There will obviously be specific regional differences based on available expertise, socioeconomic factors, regulatory requirements and availability of resources. As such, the EBPG can be regionally adapted to take account of these constraints. To facilitate international applicability, the following comments address specific areas of the EBPG for Peritoneal Dialysis which are likely to necessitate regional modification of protocols and management.
Data	06.02.2007

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