Renal Association Clinical Practice Guideline on Planning, Initiating and Withdrawal of Renal Replacement Therapy

This guideline provides recommendations on best practice in the planning, initiating and withdrawal of renal replacement therapy. The guideline links with many of the objectives relating to renal replacement therapy described within the National Service Framework for Renal Services Part 1 [1]. This NSF document highlighted the need for renal units to deliver individualised patient education to allow patients to make an informed choice of treatment modality, timely preparation for renal replacement therapy and empowerment of the patient from the start to the end of their treatment pathway. In the preparation of this guideline the authors performed a systematic search of the literature on planning and initiating of renal replacement therapy and end of life care which was published in English up to February 2009. The evidence for these recommendations has been assessed using the modified GRADE system. The modified GRADE system defines both the strength of the recommendations of the guideline authors and the level of evidence upon which each of the recommendations is based. This grading system classifies expert recommendations as ‘strong’ (Grade 1) or ‘weak’ (Grade 2) based upon the balance between the benefits and risks, burden and cost. The quality or level of evidence is designated as high (Grade A), moderate (Grade B), low (Grade C) or very low (D) depending on factors such as study design, directness of evidence