Introduction

Abstract

IT IS A HUMBLING experience to edit and contribute to an issue of Seminars in Nephrology dedicated to an arena of knowledge in which one has no specific specialized training. (No, not Nephrology, outcomes research.) However, the general training and experience common to Internal Medicine and Nephrology are implicitly based on outcomes. At base, Medicine itself demands that its practitioners provide 2 basic services to patients: first, the prevention of premature and untimely death, and second, the reduction of suffering. Internists and Nephrologists are trained to choose therapies that are, to one degree or another, known, or, at least believed, to work. In general, they also modify their selections based on the impact of the therapy in question on the quality of life of the patient. Outcomes research uses the tools of epidemiology, survey, and cost-benefit analysis (among others), to more precisely define if these 2 great aims are met. Dr. James Rohrer, in the first of these pages, provides a much more detailed overview of what outcomes research can entail. The other contributors to this issue deal with the problem of outcomes in a variety of conditions commonly seen by the Nephrologist, at a variety of levels depending on the nature of extant data. Where data on patient perceptions and quality of life are available, these data are considered. However, one cannot comment on quality-of-life issues in the absence of a mature data pool bearing on the impact of one or more treatments on patient perceptions. The questions in some areas, such as which of the treatment options available for primary glomerulonephritides is preferable, remain at the level of efficacy. At some point one will have to compare the cost of treatment relative to results and the importance of the side effects of therapy, but these issues cannot be addressed until there is agreement as to which treatments have the best efficacy. Within these pages Dr. Toto considers the prevention of renal failure in diabetic patients, Dr. Cattran reviews the data on treatment of primary glomerular disease, and Dr. Mailloux evaluates interventions in renovascular disease. Dr. Mehta provides a review of the current treatment of acute renal failure, and Dr. Dhingra and myself have reviewed the data on outcomes in hemodialysis. Transplant outcomes and the impact of new drugs are considered by Dr. Pirsch. Finally, the impact of a nonrenal intervention, smoking cessation, on a variety of renal outcomes is presented by Dr. Wesson. These articles reflect the state of outcomes research in Nephrology to date. A larger contribution from outcomes studies will surely come with time. For now, though, much of the data remains at a relative early stage of development. To paraphrase (albeit very loosely) John Adams: We now study effectiveness of interventions in the short term, so that our academic children may study the effectiveness of these interventions over the long term, so that their academic children may uncover the best ways to improve both short-term and long-term quality of life.