A critical appraisal of chronic kidney disease mineral and bone disorders clinical practice guidelines using the AGREE II instrument
- 537 Downloads
Patients with chronic kidney disease mineral and bone disorders (CKD-MBD) suffer high rates of morbidity and mortality, in particular related to bone and cardiovascular outcomes. The management of CKD-MBD remains challenging. The objective of this systematic survey is to critically appraise clinical practice guidelines (CPGs) addressing CKD-MBD.
Data sources included MEDLINE, EMBASE, the National Guideline Clearinghouse, Guideline International Network and Turning Research into Practice up to May 2016. Teams of two reviewers, independently and in duplicate, screened titles and abstracts and potentially eligible full text reports to determine eligibility and subsequently appraised the guidelines using the Advancing Guideline Development, Reporting and Evaluation in Health Care instrument II (AGREE).
Sixteen CPGs published from 2003 to 2015 addressing the diagnosis and management of CKD-MBD in adult patients (11 English, two Spanish, one Italian, one Portuguese and one Slovak) proved eligible. The National Institute for Health and Care Excellence guideline performed best with respect to AGREE II criteria; only three other CPGs warranted high scores on all domains. All other guidelines received scores of under 60% on one or more domains. Major discrepancies in recommendations were not, however, present, and we found no association between quality of CPGs which was not associated with resulting recommendations.
Most guidelines assessing CKD-MBD suffer from serious shortcomings using AGREE criteria although limitations with respect to AGREE criteria do not necessarily lead to inappropriate recommendations.
KeywordsChronic kidney disease Advancing guideline development Reporting and evaluation in health care instrument Clinical practice guidelines Mineral and bone disorder
Compliance with ethical standards
Conflict of interest
Authors have no conflict of interest.
Human rights and animal statement
This article does not contain any studies with human participants or animals performed by any of the authors.
- 2.National Institutes of Health NIoDaDaKD (2015) United States renal data system. 2015 USRDS annual data report: epidemiology of kidney disease in the United States. United States Renal Data System, BathesdaGoogle Scholar
- 8.Group KDIGOKCW: KDIGO (2012) Clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int 2013(3):1–150Google Scholar
- 10.Sanchez-Perales C, Vazquez Ruiz de Castroviejo E, Garcia-Cortes MJ, Biechy Mdel M, Gil-Cunquero JM, Borrego-Hinojosa J et al (2015) Valvular calcifications at the start of dialysis predict the onset of cardiovascular events in the course of follow-up. Nefrologia 35(2):157–163. doi: 10.1016/j.nefro.2015.05.017 CrossRefPubMedGoogle Scholar
- 11.Rebic D, Rasic C (2015) Valvular calcification and left ventricular modifying in peritoneal dialysis patients. Renal Fail 19:1–7Google Scholar
- 13.Arenas MD, Alvarez-Ude F, Gil MT et al (2007) Implementation of ‘K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease’ after the introduction of cinacalcet in a population of patients on chronic haemodialysis. Nephrol Dial Transpl 22(6):1639–1644CrossRefGoogle Scholar
- 20.Patel L, Bernard M (2015) Sevelamer versus calcium-based binders for treatment of hyperphosphatemia in CKD: a meta-analysis of randomized controlled trials. Clin J Am Soc Nephrol 14:06800615Google Scholar
- 21.Meyer C, Cameron K, Battistella M (2012) New agent to treat elevated phosphate levels: magnesium carbonate/calcium carbonate tablets. CANNT J J ACITN 22(4):33–35 quiz 36-37 Google Scholar
- 29.National Kideny Foudation (2003) K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 42(4 Suppl 3):S1–201Google Scholar
- 31.Centre for Clinical Practice at N (2013) National Institute for Health and Clinical Excellence: Guidance. Hyperphosphataemia in chronic kidney disease: management of hyperphosphataemia in patients with stage 4 or 5 chronic kidney disease. National Institute for Health and Clinical Excellence (UK)Copyright (c) National Institute for Health and Clinical Excellence, ManchesterGoogle Scholar
- 32.(2014) Hyperphosphataemia in chronic kidney disease evidence update December 2014. NICE guidelinesGoogle Scholar
- 35.Hawley C, Elder G (2006) The CARI guidelines. Biochemical targets. Nephrology (Carlton, Vic) 11(Suppl 1):S198–S216Google Scholar
- 36.Section IV. bone disease (2002) Nephrology Dialysis Transplantation, vol 17, pp 43–48. http://resolver.scholarsportal.info/resolve/09310509/v17inone_s4/43_ibd
- 37.Stedon S, Sharples E (2015) Clinical practice guideline CKD-mineral and bone disorders (CKD-MBD). http://www.renal.org/docs/default-source/default-document-library/ra-ckd-mbd-finalversion-2015-v2870fa131181561659443ff000014d4d8.pdf?sfvrsn=0
- 42.Prados-Garrido MD, Bover J, Teresa González-Álvarez M (2011) Clinical practice guideline for chronic kidney disease-mineral and bone disease (2010 version). Dialisis Transplante 32(3):108–118Google Scholar
- 43.Mazzaferro S, Cozzolino M, Marangella M, Strippoli GF, Messa P (2007) Calcimimetics, phosphate binders, vitamin D and its analogues for treating secondary hyperparathyroidism in chronic kidney disease: guideline from the Italian Society of Nephrology. Giornale italiano di nefrologia 24(Suppl 37):S107–S124PubMedGoogle Scholar
- 45.Anonymous (2009) Guidelines of the Ministry of Health of the Slovak Republic for the treatment of bone and mineral metabolism disorders in patients with chronic kidney disease. Aktuality v Nefrologii 15(3):121–127Google Scholar