Sood Manish M, Manns Braden, Nesrallah Gihad
aOttawa Hospital Research Institute (OHRI), Department of Medicine, The Ottawa Hospital, Ottawa bFoothills Hospital, University of Calgary, Calgary cHumber River Hospital dThe Li Ka Shing Knowledge Institute, Keenan Research Centre, St. Michael's Hospital, Toronto, Canada.
Curr Opin Nephrol Hypertens. 2014 May;23(3):321-7. doi: 10.1097/01.mnh.0000445746.85502.42.
The optimal time at which to initiate chronic dialysis remains unknown. Using a contemporary knowledge translation approach (the knowledge-to-action framework), a pan-Canadian collaboration (CANN-NET) set out to study the scope of the problem, then develop and disseminate evidence-based guidelines addressing the timing of dialysis initiation. The purpose of this review is to summarize the key findings and describe the planned Canadian knowledge translation strategy for improving knowledge and practices pertaining to the timing dialysis initiation.
New research has provided considerable insights regarding the initiation of dialysis. A Canadian cohort study identified significant variation in the estimated glomerular filtration rate level at dialysis initiation, and a survey of providers identified related knowledge gaps that might be amenable to knowledge translation interventions. A recent knowledge synthesis/guideline concluded that early dialysis initiation is costly, and provides no measureable clinical benefits. A systematic knowledge translation intervention including a multifaceted approach may aid in reducing variation in practice and improving the quality of care.
Utilizing the knowledge-to-action framework, we identified practice variation and key barriers to the optimal timing for dialysis initiation that may be amenable to knowledge translation strategies.
开始慢性透析的最佳时间仍不明确。通过采用当代知识转化方法（知识到行动框架），一个泛加拿大合作项目（CANN-NET）着手研究该问题的范围，然后制定并传播关于透析开始时间的循证指南。本综述的目的是总结关键发现，并描述加拿大为改善与透析开始时间相关的知识和实践而计划采用的知识转化策略。
新的研究为透析开始提供了相当多的见解。一项加拿大队列研究发现透析开始时估计肾小球滤过率水平存在显著差异，对医疗服务提供者的一项调查确定了可能适合知识转化干预的相关知识差距。最近的一项知识综合/指南得出结论，早期开始透析成本高昂，且没有可衡量的临床益处。包括多方面方法的系统性知识转化干预可能有助于减少实践差异并提高护理质量。
利用知识到行动框架，我们确定了透析开始最佳时间的实践差异和关键障碍，这些可能适合知识转化策略。
