This current version provides a summary of recommen-dations for best practice in creating peritoneal accessfor patients on peritoneal dialysis (PD). A more detailedreview of peritoneal access is available in the report fromthe Renal Association Working Party on Peritoneal Access(final version April 2008) available at www.renal.org .

　　These guidelines are evidence based where such evi-dence exists. The published literature was reviewed atwww.ncbi.nlm.nih.gov/pubmed using the search term“peritoneal dialysis catheter,” identifying 2320 refer-ences. Adding the term “trial” reduced this number to216. These were individually reviewed to identify pos-sible randomized controlled trials, meta-analyses,guidelines, and reviews that would be considered in thepreparation of the document. The document has beenreviewed by all authors and has been placed for consul-tation on the Renal Association Web site and discussedat the Clinical Guidelines Committee. It has also beenreviewed by a consumer research panel run by Jane Ash(Special Projects Administrator, North and East Yorkshireand Northern Lincolnshire Comprehensive Local Re-search Network) and by renal patients in Sheffield,United Kingdom.

　　The evidence for these recommendations has beenassessed using the modified GRADE system. The modi-fied GRADE system defines both the strength of the rec-ommendations of the guideline authors and the level ofevidence upon which each of the recommendations isbased. This grading system classifies expert recommen-dations as “strong” (Grade 1) or “weak” (Grade 2) basedupon the balance between the benefits and risks, bur-den, and cost. The quality or level of evidence is desig-nated as high (Grade A), moderate (Grade B), low(Grade C), or very low (Grade D) depending on factorssuch as study design, directness of evidence, and con-sistency of results. Grades of recommendation and qual-ity of evidence may range from 1A to 2D.

　　The GRADE system was developed by an internationalgroup of guideline developers and methodologists tomaximize the usefulness of clinical practice guidelinesin the management of typical patients (1–7). Most guide-line organizations recognize the need for a standardgrading scheme and the GRADE system has been adoptedby many leading organizations, including NICE, SIGN,KDIGO, ERBP, and KDOQI, as well as UpToDate (8,9).
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