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yet this same type of methodology aids in generating our paradigms for clinical practice through a critical analysis of the results obtained&#46;</p><p class="elsevierStylePara">In this context&#44; in 2010&#44; Ricardo Arias asked me&#44; as I imagine he asked several other senior Spanish nephrologists&#44; for my opinion regarding the establishment of a work group in our country with the goal of reviewing and establishing guidelines and treatment algorithms for caring for patients in the dialysis units managed by FMC in Spain&#46; After considering the request&#44; I formally proposed the creation of a Spanish ARO&#44; with a similar framework and purpose to that of the European group&#46; I had several reasons for making this suggestion&#44; but my primary reason was the observation that the EuCliD system was working at the same level in Spain as in the rest of Europe&#46; In addition&#44; we had at our disposal the support and collaboration of Pedro Costa and Jose Ignacio Merello&#44; who had invested considerable time and enthusiasm into the development and maintenance of the database&#44; reaching a total of more than 5000 patients registered&#44; corresponding to a total of 800&#160;000 haemodialysis sessions per year&#46; It was not difficult to convince him&#59; Ricardo quickly accepted the idea and started working to materialise it and to organise the logistics&#46; We came to an agreement that we would later establish in a document in which Ricardo Arias&#44; in the name of FMC&#44; would formally propose nephrologists for membership in the group&#46; In return&#44; we would be granted unrestricted access by FMC to the EuCliD<span class="elsevierStyleSup">&#174;</span> database for scientific purposes&#44; including publications in specialist journals&#46; I was provided with a list of the group members&#58; Alejandro Mart&#237;n-Malo&#44; &#193;ngel L&#46;M&#46; de Francisco&#44; Manuel Praga&#44; Jose Lu&#241;o&#44; Rafael P&#233;rez-Garc&#237;a&#44; Francisco Maduell&#44; Manuel Molina and Eduardo Mirapeix&#44; who was replaced last year due to retirement by Jesus Bustamante&#46; FMC was represented by Ciro Tetta&#44; Daniele Marcelli&#44; Jose Ignacio Merello&#44; and In&#233;s Palomares&#44; in addition to the irreplaceable Pedro Costa&#46;</p><p class="elsevierStylePara">After the group was consolidated and charged with three established topics of investigation&#44; I proposed a name for the group&#58; ORD &#40;Optimising Results in Dialysis&#41;&#46; While the word &#8220;outcomes&#8221; is a better English translation for the Spanish word <span class="elsevierStyleItalic">resultados</span>&#44; we preferred the word &#8220;results&#8221; in order to take into account not only clinical results&#44; but also topics related to the efficiency and sustainability of dialysis treatments&#44; which are of such great importance in the current economic situation&#46;</p><p class="elsevierStylePara">During the first meeting&#44; we established that the objectives of the ORD would be the same as those of the ARO&#44; counting on the essential support of the company&#8217;s medical department&#58; Ciro Tetta and Jose Ignacio Merello&#44; in addition to the financial department represented by Pedro Costa&#46; The logistics and delivery of specific Spanish data from the European EuCliD<span class="elsevierStyleSup">&#174;</span> system would be coordinated by Vice President Daniele Marcelli and Inga Bayh&#46; Over time&#44; and in light of the activities carried out&#44; both Ciro and Daniele have requested permission to attend all work group meetings and sessions&#46; We have accepted this proposal for obvious reasons&#46;</p><p class="elsevierStylePara">In this manner&#44; we started to function as a cohesive group&#44; enjoying extensive and exciting work group sessions starting in June 2010&#46; To date&#44; we have met during 7 group sessions as well as in a multitude of e-mail communications and conference calls&#46; In several of these meetings&#44; we have invited guest speakers as well&#58; Andrea Stopper&#44; Jordi Mart&#237;&#44; Flavio Mari&#44; Alberto Rosati&#44; and Inga Bayh have all received formal requests to elaborate on the topics that our group has been developing&#46; Having known Bernard for more than 25 years&#44; and having worked with him on innumerable projects and collaborative studies&#44; I would dare to predict that he will join the ORD without even giving us time to suggest the idea&#46; Without a doubt&#44; his addition to the group will bring immeasurable benefits in the form of his ideas and experience&#46; In effect&#44; the joint work between Bernard and Ciro will be a productive collaboration that will bring us closer to our goals&#46; This will be a unique&#44; original&#44; and distinctive experience for our group&#46;</p><p class="elsevierStylePara">The current situation of the ORD work group involves 6 active projects assessing and analysing the Spanish EuCliD<span class="elsevierStyleSup">&#174;</span> database&#59; three manuscripts have been concluded for the consideration of the editors at their respective nephrology journals&#46; In addition&#44; we have reviewed and updated three guidelines&#47;algorithms for treatment strategies&#58; <span class="elsevierStyleItalic">Dosing in haemodialysis&#44; Treatment of osteodystrophy&#44; </span>and<span class="elsevierStyleItalic"> Managing anaemia</span>&#44; for implementation in haemodialysis units&#46; These projects were a response to the requests from Armin Karch&#44; who has always closely monitored quality control of clinical health care provided in dialysis units&#46; With time&#44; we hope that these documents will come to be discussed in other European countries in a similar manner to the implementation taking place in the United States&#46;</p><p class="elsevierStylePara">The first formal study published by the ORD work group appears in this issue of <span class="elsevierStyleItalic">Nefrolog&#237;a</span><span class="elsevierStyleSup">4</span> as a starting shot on its journey through the nephrological literature&#46; This publication is a description of the database with the most relevant hierarchical configuration for Spanish patients&#46; It goes without saying that special acknowledgement of the work group is in order&#44; but special mention is deserved for Rafael P&#233;rez&#44; In&#233;s Palomares&#44; and Ignacio Merello for their long hours spent organising and referencing the EuCliD<span class="elsevierStyleSup">&#174;</span> database&#46; We would also like to thank the team directed by Daniele Marcelli&#44; in particular Inga Bayh&#44; for their dedication to ensuring the validity and reliability of the data&#59; without their professional collaboration&#44; our work would be impossible&#46;</p><p class="elsevierStylePara">We hope that our other original articles&#44; which will be sent for publication in the coming weeks&#44; will be of interest to the editors and reviewers of nephrological journals&#44; such that the group can emerge within the nephrological literature with a certain personality and style&#46; Dedication&#44; talent&#44; and creativity will not be lacking&#59; these qualities&#44; together with the cooperation and mutual understanding shown among the active members of the FMC corporation&#44; will ensure that the ORD follows the course set by the ARO&#46; It goes without saying that Amgen should also be included and allowed to exert its influence and collaboration on our initiative due to both its analogy and talent&#46; To this end&#44; we hope that our message of inclusion to Amgen will reach and be deemed appropriate by the representatives of the administrations&#46;</p><p class="elsevierStylePara">Without a doubt&#44; given the current complex financial situation&#44; it will require new efforts in imagination and creativity to guarantee the sustainability of our activities and system&#44; including continued training&#44; technological innovation&#44; and excellence in research in order to continue our advancements&#46; Therein lie our greatest and most relevant doubts&#46; However&#44; time&#44; the nephrological community in Spain&#44; and the renal patients treated in our field of medicine will be the ultimate judges of the results achieved under the ORD initiative&#46; 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ORD Work and Initiative Group ('Optimising Results in Dialysis')
Grupo de Trabajo e Iniciativa ORD (Optimizando Resultados en Diálisis, «Optimising Results in Dialysis»)
Pedro Aljamaa, Pedro Aljamaa
a Servicio de Nefrología, Hospital Universitario Reina Sofía, Córdoba,
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    "textoCompleto" => "<p class="elsevierStylePara">As one of the initiatives set forth in the Scientific Collaboration Agreement between Amgen and Fresenius Medical Care &#40;FMC&#41;&#44; the ARO Work Group was established in mid-2007&#46; Many nephrologists are still unaware of the characteristics and objectives of this group&#59; they are not even familiar with the meaning of the acronym&#44; group members&#44; or the goals they attempt to achieve&#46; However&#44; this work group has produced several original articles of great interest in nephrological journals&#59; it has also generated presentations at conferences of the European Renal Association-European Dialysis and Transplant Association &#40;ERA-EDTA&#41; and the American Society of Nephrology &#40;ASN&#41; in the last two years&#46;</p><p class="elsevierStylePara">ARO corresponds to the acronym for <span class="elsevierStyleBold">A</span>nalysing data&#44; <span class="elsevierStyleBold">R</span>ecognising excellence&#44; and <span class="elsevierStyleBold">O</span>ptimising outcomes in advanced chronic kidney disease&#46; This group consists of the nephrologists J&#252;rgen Floege&#44; Kai-Uwe Eckardt&#44; Iain Macdougall&#44; Bernard Canaud&#44; Tilman Dr&#252;eke&#44; Peter Stevinkel&#44; &#193;ngel L&#46;M&#46; de Francisco&#44; David Wheeler&#44; and Pedro Aljama&#44; as well as several cardiovascular&#44; epidemiological&#44; and database analysis experts&#44; in addition to representatives of the administrations of both companies&#46; Due to his recent appointment as the strategic medical board director in the medical department of FMC&#44; Bernard Canaud will be replaced by another European nephrologist at the request of the group&#46; Two or three meetings are held every year&#44; in addition to conference calls whenever required by the activities of the work group&#46;</p><p class="elsevierStylePara">The ARO initiative is based on the primary objective of searching for answers to current major clinical questions regarding the treatment of chronic kidney disease&#44; with special emphasis on the unsatisfactory survival results obtained using the different methods of dialysis&#46; To this end&#44; the ARO group has set the goal of optimising clinical results in dialysis programmes through a detailed analysis of available epidemiological profiles&#46; Using clinical information and patient health profiles&#44; the ARO group applies an analytical methodology that provides the best possible scientific evidence to be used for making decisions and creating treatment paradigms&#46;</p><p class="elsevierStylePara">In this manner&#44; the agreement between the two companies&#44; Amgen and FMC&#44; includes establishing a framework for referencing and analysing the FMC database known as EuCliD<span class="elsevierStyleSup">&#174;</span>&#46; Using the unrestricted information contained within this digital database&#44; the work group uses protocols established in concrete studies previously approved by the group to carry out scientific research and management&#46; Naturally&#44; the initial idea seemed fascinating to all of us&#46; In effect&#44; here was a database providing information on a cohort of 11&#160;000 incident and prevalent patients&#59; in other words&#44; approximately 15&#160;000 patients-year in 2005-2006&#46; We began to work in this context&#44; and this collaboration has produced several publications on various subjects&#44; such as a description of the clinical characteristics of the patient database&#44;<span class="elsevierStyleSup">1</span> relevant parameters of osteodystrophy related to mortality&#44;<span class="elsevierStyleSup">2</span> and a study on the variability of haemoglobin and its true clinical significance&#46;<span class="elsevierStyleSup">3</span> This last contribution&#44; which appeared in the Journal of the American Society of Nephrology&#44; is without a doubt the most precise report to date of this interesting issue&#46; Studies always stipulate the limitations inherent to observational and retrospective studies&#44; yet this same type of methodology aids in generating our paradigms for clinical practice through a critical analysis of the results obtained&#46;</p><p class="elsevierStylePara">In this context&#44; in 2010&#44; Ricardo Arias asked me&#44; as I imagine he asked several other senior Spanish nephrologists&#44; for my opinion regarding the establishment of a work group in our country with the goal of reviewing and establishing guidelines and treatment algorithms for caring for patients in the dialysis units managed by FMC in Spain&#46; After considering the request&#44; I formally proposed the creation of a Spanish ARO&#44; with a similar framework and purpose to that of the European group&#46; I had several reasons for making this suggestion&#44; but my primary reason was the observation that the EuCliD system was working at the same level in Spain as in the rest of Europe&#46; In addition&#44; we had at our disposal the support and collaboration of Pedro Costa and Jose Ignacio Merello&#44; who had invested considerable time and enthusiasm into the development and maintenance of the database&#44; reaching a total of more than 5000 patients registered&#44; corresponding to a total of 800&#160;000 haemodialysis sessions per year&#46; It was not difficult to convince him&#59; Ricardo quickly accepted the idea and started working to materialise it and to organise the logistics&#46; We came to an agreement that we would later establish in a document in which Ricardo Arias&#44; in the name of FMC&#44; would formally propose nephrologists for membership in the group&#46; In return&#44; we would be granted unrestricted access by FMC to the EuCliD<span class="elsevierStyleSup">&#174;</span> database for scientific purposes&#44; including publications in specialist journals&#46; I was provided with a list of the group members&#58; Alejandro Mart&#237;n-Malo&#44; &#193;ngel L&#46;M&#46; de Francisco&#44; Manuel Praga&#44; Jose Lu&#241;o&#44; Rafael P&#233;rez-Garc&#237;a&#44; Francisco Maduell&#44; Manuel Molina and Eduardo Mirapeix&#44; who was replaced last year due to retirement by Jesus Bustamante&#46; FMC was represented by Ciro Tetta&#44; Daniele Marcelli&#44; Jose Ignacio Merello&#44; and In&#233;s Palomares&#44; in addition to the irreplaceable Pedro Costa&#46;</p><p class="elsevierStylePara">After the group was consolidated and charged with three established topics of investigation&#44; I proposed a name for the group&#58; ORD &#40;Optimising Results in Dialysis&#41;&#46; While the word &#8220;outcomes&#8221; is a better English translation for the Spanish word <span class="elsevierStyleItalic">resultados</span>&#44; we preferred the word &#8220;results&#8221; in order to take into account not only clinical results&#44; but also topics related to the efficiency and sustainability of dialysis treatments&#44; which are of such great importance in the current economic situation&#46;</p><p class="elsevierStylePara">During the first meeting&#44; we established that the objectives of the ORD would be the same as those of the ARO&#44; counting on the essential support of the company&#8217;s medical department&#58; Ciro Tetta and Jose Ignacio Merello&#44; in addition to the financial department represented by Pedro Costa&#46; The logistics and delivery of specific Spanish data from the European EuCliD<span class="elsevierStyleSup">&#174;</span> system would be coordinated by Vice President Daniele Marcelli and Inga Bayh&#46; Over time&#44; and in light of the activities carried out&#44; both Ciro and Daniele have requested permission to attend all work group meetings and sessions&#46; We have accepted this proposal for obvious reasons&#46;</p><p class="elsevierStylePara">In this manner&#44; we started to function as a cohesive group&#44; enjoying extensive and exciting work group sessions starting in June 2010&#46; To date&#44; we have met during 7 group sessions as well as in a multitude of e-mail communications and conference calls&#46; In several of these meetings&#44; we have invited guest speakers as well&#58; Andrea Stopper&#44; Jordi Mart&#237;&#44; Flavio Mari&#44; Alberto Rosati&#44; and Inga Bayh have all received formal requests to elaborate on the topics that our group has been developing&#46; Having known Bernard for more than 25 years&#44; and having worked with him on innumerable projects and collaborative studies&#44; I would dare to predict that he will join the ORD without even giving us time to suggest the idea&#46; Without a doubt&#44; his addition to the group will bring immeasurable benefits in the form of his ideas and experience&#46; In effect&#44; the joint work between Bernard and Ciro will be a productive collaboration that will bring us closer to our goals&#46; This will be a unique&#44; original&#44; and distinctive experience for our group&#46;</p><p class="elsevierStylePara">The current situation of the ORD work group involves 6 active projects assessing and analysing the Spanish EuCliD<span class="elsevierStyleSup">&#174;</span> database&#59; three manuscripts have been concluded for the consideration of the editors at their respective nephrology journals&#46; In addition&#44; we have reviewed and updated three guidelines&#47;algorithms for treatment strategies&#58; <span class="elsevierStyleItalic">Dosing in haemodialysis&#44; Treatment of osteodystrophy&#44; </span>and<span class="elsevierStyleItalic"> Managing anaemia</span>&#44; for implementation in haemodialysis units&#46; These projects were a response to the requests from Armin Karch&#44; who has always closely monitored quality control of clinical health care provided in dialysis units&#46; With time&#44; we hope that these documents will come to be discussed in other European countries in a similar manner to the implementation taking place in the United States&#46;</p><p class="elsevierStylePara">The first formal study published by the ORD work group appears in this issue of <span class="elsevierStyleItalic">Nefrolog&#237;a</span><span class="elsevierStyleSup">4</span> as a starting shot on its journey through the nephrological literature&#46; This publication is a description of the database with the most relevant hierarchical configuration for Spanish patients&#46; It goes without saying that special acknowledgement of the work group is in order&#44; but special mention is deserved for Rafael P&#233;rez&#44; In&#233;s Palomares&#44; and Ignacio Merello for their long hours spent organising and referencing the EuCliD<span class="elsevierStyleSup">&#174;</span> database&#46; We would also like to thank the team directed by Daniele Marcelli&#44; in particular Inga Bayh&#44; for their dedication to ensuring the validity and reliability of the data&#59; without their professional collaboration&#44; our work would be impossible&#46;</p><p class="elsevierStylePara">We hope that our other original articles&#44; which will be sent for publication in the coming weeks&#44; will be of interest to the editors and reviewers of nephrological journals&#44; such that the group can emerge within the nephrological literature with a certain personality and style&#46; Dedication&#44; talent&#44; and creativity will not be lacking&#59; these qualities&#44; together with the cooperation and mutual understanding shown among the active members of the FMC corporation&#44; will ensure that the ORD follows the course set by the ARO&#46; It goes without saying that Amgen should also be included and allowed to exert its influence and collaboration on our initiative due to both its analogy and talent&#46; To this end&#44; we hope that our message of inclusion to Amgen will reach and be deemed appropriate by the representatives of the administrations&#46;</p><p class="elsevierStylePara">Without a doubt&#44; given the current complex financial situation&#44; it will require new efforts in imagination and creativity to guarantee the sustainability of our activities and system&#44; including continued training&#44; technological innovation&#44; and excellence in research in order to continue our advancements&#46; Therein lie our greatest and most relevant doubts&#46; However&#44; time&#44; the nephrological community in Spain&#44; and the renal patients treated in our field of medicine will be the ultimate judges of the results achieved under the ORD initiative&#46; In any event&#44; we have faith in our good judgement and firm commitment to improving the clinical results of patients with renal failure&#59; without a doubt&#44; this is the greatest scientific challenge facing the nephrological community today&#46;<span class="elsevierStyleSup">5</span></p>"
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