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International CKD guidelines coming soon for diabetes, transplant candidates
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As the structure grows internally for Kidney Disease: Improving Global Outcomes, the nonprofit organization has work in the pipeline that includes new guidelines under development, outdated guidelines under revision and changes in process to make work more efficient and accessible. John Davis, the CEO of Kidney Disease: Improving Global Outcome (KDIGO), shared the new and update guidelines and processes in the works with Nephrology News & Issues.
Streamlined process, global focus
Guideline development and revision will be overseen by Amy Earley, the organization’s first – guideline development director. Additionally, the group’s executive committee contributes to both the topics selected for new guidelines and the revision of existing guidelines. The executive committee’s input is essential for the organization’s work to maintain a global scope; while its staff are based in the United States, the executive committee represents a diverse array of countries in Europe, Asia and Africa, as well as Canada and Mexico.
“They meet twice a year, 20 people from all over the world and their job at one of these meetings is to prioritize the topics we have received” as suggestions for new guidelines, Davis said. This process helps KDIGO to ensure before committing to a new guideline that the topic has international relevance. The executive committee also weighs in on the topics of the Controversies Conferences, Davis added.
KDIGO’s methodology for guidelines is currently being updated under the leadership of methods chair, Marcello Tonelli. The process includes a new electronic publishing platform, new presentation of recommendations and practice points as well as keeping the length of guideline documents reasonable.
Currently in development
Each new guideline typically takes about three years of development from the initial selection of the topic to publication of the guideline, according to Davis. Some considerations before a topic is chosen include its level of urgency, its relevance and the cost to develop a guideline – as a nonprofit organization with a small staff, KDIGO does not use industry funding for its guidelines and thus needs strong support from the volunteers who comprise its guideline work groups.
The newest guideline from the KDIGO is on the evaluation and management of candidates for kidney transplantation. This guideline’s public review period recently ended and the final guideline is being prepared for publication in the Transplantation – the official journal of The Transplantation Society, Davis said.
Its next new guideline will focus on diabetes, for which a scope of work is publicly available. The work group for this guideline held its first meeting in January and Earley was hired January 1, so she was able to attend this important meeting and join initial discussions. According to the scope of work — which could change based on public comment and evidence review — this guideline, “Diabetes and CKD,” will cover primary and secondary prevention of CKD progression among people with diabetes; measurement and management of glycemia in CKD; lifestyle and nutrition among people who have both diabetes and CKD; and cardiovascular management among people who have both diabetes and CKD.
The evidence review for this guideline is being conducted by an ERT from Cochrane Kidney and Transplant based in Australia. Cochrane will help to grade the quality of evidence for each recommendation. Using the evidence review, the work group will draft recommendations and practice points that will comprise the draft guideline to be presented for public review. The public review of this guideline is slated to the end of this year. “We get 200 or so [comments] every time we do this,” Davis said. The final diabetes guideline will be published in Kidney International, the official journal of the International Society of Nephrology.
Updates under way
Davis and Earley said updates to guidelines becomes more important over time as new evidence is published. “With the constant publication of new research in kidney disease, it is important to assess the impact on recommendation statements made in previously published guidelines,” Earley said. “When enough evidence is established to warrant a reevaluation of our previous recommendations, we will consider a full update to the guideline.”
KDIGO is revising outdated portions of two guidelines from 2012: “Glomerulonephritis (GN)” and “Management of Blood Pressure in CKD.” The GN guideline was the first published on the topic. “That is a complicated [topic],” Davis said. “It has 11 different diseases, so it is a big one.”
The Blood Pressure Update Work Group will consider each recommendation in light of new evidence released since the 2010, including the most recent publication of the Systolic Blood Pressure Intervention Trial (SPRINT).
‘Rapid recommendations’ to come
Earley noted KDIGO is also looking to improve the efficiency of updates by creating a separate process for single recommendations; instead of reevaluating an entire guideline, the ERT would conduct an focused systematic review and then the work group would develop a “rapid recommendation” revision to the outdated recommendation statement(s) within the guideline individually. “These rapid recommendations allow for more timely updates to some of the key recommendations within each guideline and ensure the guidelines are continuing to evolve with the latest evidence,” Earley said.– by Amanda Alexander
References:
Kidney Disease: Improving Global Outcomes (KDIGO). Proposed Scope of Work for KDIGO Clinical Practice Guideline on the Management of Diabetes and Chronic Kidney Disease. 2018. Retrieved from https://kdigo.org/wp-content/uploads/2018/03/KDIGO-DM-GL-SoW-Public-Review-FINAL.pdf
Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Inter Suppl. 2012;2:337-414.
Kidney Disease: Improving Global Outcomes (KDIGO) Glomerulonephritis Work Group. KDIGO Clinical Practice Guideline for Glomerulonephritis. Kidney Inter Suppl. 2012;2:139-274.
Disclosures: Davis and Earley report no relevant financial disclosures.