Saturday, March 10, 2012

Dialysis Unplugged: Fresenius’s MONDO initiative

Mondo has several different definitions, such as "very", or "big". Lets keep this definition in mind as we examine the MONDO initiative launched by Fresenius’s Renal Research Initiative. More details are available here.

RRI describes the MONDO initiative as follows: “the MONDO (MONitoring Dialysis
Outcomes) initiative …encompasses multiple data bases from around the world. MONDO’s goal is to gain a better understanding of the natural history of chronic dialysis patients on a global scale.

So far, it seems that “RRI and its partners have collected longitudinal per-patient data in 155,000 patients from 27 countries on five continents (Asia, Europe, North America, South America, and Australia). In the MONDO initiative, RRI collaborates with the following partners: Fresenius Medical Care (FMC) Europe, FMC Asia Pacific, FMC Latin America, FMC Canada, University of Maastricht (The Netherlands), University of California at Santa Barbara, and the Kuratorium für Heimdialyse und Nierentransplantation (Germany).”

The goal is to study “temporal trends of surrogate outcome indicators”; as well as “for the future development of predictive models, which might aid the clinician in identifying patients at risk for adverse outcomes”. MONDO also asks the question: “are US clinical practices or US dialysis population characteristics different from those of the rest of the world?”

I am pretty certain that this initiative must be costing several hundred thousand dollars each year. The question I would ask is this: what is the most important question we need to answer in managing dialysis patients?

Surely, the question should be "Is more dialysis better?" Shouldn’t a dialysis company of the global scale and deep pockets of Fresenius want to know the answer to this question? Instead, it is spending money and resources on research that is unlikely to change clinical practice.

Mondo!