Clinical decision making in nephrology...renal function might not be the most important thing to measure

There is evidence of substantial international and regional variation in the provision of Renal Replacement Therapy (RRT). Utilisation review studies and surveys of professional opinion have not yet disentangled the relative importance of renal and non-renal factors influencing key clinical decisions affecting access to RRT. Professional bodies have not produced prescriptive guidelines but the fundamental decision making areas relate to prognostication and the weighing up of patient utilities with or without particular forms of treatment. Increasingly techniques of quantitative judgment analysis are being used to clarify the decision drivers. There is a pressing need to understand and diagnose the decision making problem and the choice of intervention to improve clinical decision making must ultimately depend on clinical context.