Historically clinical decisions in renal medicine have been challenged by the scarce
availability of robust supportive evidence. Not only are the number of randomized controlled
trials (RCTs) in Nephrology the third lowest amongst the medical specialties but in many
instances the trials themselves are of poor quality. In addition practice has been further
influenced by extrapolation from the outcomes of general population clinical trials which
exclude renal patients. The difference between the ideal trial participant and real complex
cases encountered in daily practice is well recognized and further compounded in renal patients
with complex pathophysiology - this ultimately makes decision making in this subset of patients
a real challenge. Recently there has been a growing interest in conducting well designed RCTs
in different areas of renal medicine. However though clinical guidelines are helpful in
providing the clinicians with a frame of best available evidence for a clinical condition it
denies the unique nature of each individual patient. This book offers a thorough and critical
appraisal and evaluation of the key published clinical trials that have shaped current practice
in nephrology dialysis and transplantation. It will help the practicing physician close the
gap between the inflexible and generalized nature of clinical guidelines and the day-to-day
clinical decision-making for individual patients. It will provide the clinician with the tools
required to investigate and extract the appropriate guidance to apply to individual cases in
daily practice. Moreover it will help improve the ability of junior colleagues to appraise
available evidence in a systematic way when there is lack of local guidelines or when the
guidelines are difficult to apply due to logistic constraints or barriers. Lastly this book
will serve as a reference for key clinical trials in different areas of renal medicine together
with literature and authors views of these trials and their impact on changing practice.¿
