Global nephrology guidelines: a first small step in the right direction

Abstract

Guidelines for the care and cure of illnesses have been an integral component of medicine from its origins. Extant records of ancient medicine document precise recommendations of then available therapeutic options, which lend themselves to analysis as algorithms of diagnosis and treatment [1]. The 5000-year-old Babylonian Code of Hammurabi clearly states the compensation for a cure and the punishment for a poor outcome. As the priestly medicine of Mesopotamia and Egypt led to the emergence of Greek rational medicine, therein began the foundations of a scientific basis to guidelines, albeit based on individual case observations and accrued clinical experience. The beginnings of epidemiologic studies and probability mathematics during the Enlightenment added a new dimension and terminology to guidelines. The consequent complexity that resulted is perhaps best exemplified in the publication of an explanatory test titled ‘Medical Arithmetic, As a Guide and Compass Through the Labyrinth of Therapeutics’ by William Black (1749–1829). This time-honoured thread began in ancient medicine, entered an entirely novel phase in the period after the Second World War, when the expanding number of new therapeutic agents being discovered coupled with that of quantification and statistical analysis came to provide increasing measurable precision to certainty in therapeutics, and changed what started as the conjectural art of medicine into a disciplined science of clinical investigation [2]. The stage was now set for what has come to be known as evidence-based medicine, a term whose use has increased exponentially since the mid-1990s [3]. The subsequent iconic image vested in evidence-based medicine led to a parallel increase in the development of new clinical practice guidelines [4]. Thus, whereas evidence had long guided the practice of medicine, the philosophical beginnings of quantifiable evidence-based medicine in the 18th century now fuelled the generation of an overwhelming number of clinical practice guidelines in medicine [2–4].