The cost of knowledge in nephrology and the importance of clinical databases

The modern clinician uses knowledge generated on the solid ground of clinical epidemiology as a basis for clinical practice. Doctors play a leading role in continuous quality improvement of medical services, working to find and validate appropriate clinical performance measures. Large clinical databases are emerging as an important research tool for testing the performance of clinical policies in patients with chronic renal diseases. New strategies have been devised to help the clinical investigator decide when to base clinical policies on observational or randomized trial data. In the next few years the high motivation and consensus required in clinical research projects based on large data bases will certainly be created and the tantalizing managerial problems resolved.