Retrospective Analyses of Large Medical Databases

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Abstract
Dialysis has achieved widespread clinical acceptance because its efficacy is undisputed and the outcome without therapy is obvious. Patients with end-stage renal disease (ESRD) die of the complications of uremia, unless they are dialyzed or receive a renal transplant. Because the consequence of not dialyzing a patient with ESRD is so clear, dialysis was never subjected to the rigors of a prospective, randomized clinical trial. A lack of rigorous evaluation continued to characterize the development of renal replacement therapy for many years, although there were some exceptions, such as the National Cooperative Dialysis Study, which evaluated the effects of treatment time and urea removal on outcomes in hemodialysis (1). More often, retrospective, or a few prospective, clinical studies, usually in small numbers of patients, were all that were used to support changes in therapy.

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