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A critical appraisal of chronic kidney disease mineral and bone disorders clinical practice guidelines using the AGREE II instrument

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Abstract

Background

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.

Methods/design

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).

Results

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.

Conclusions

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.

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Authors and Affiliations

  1. Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada

    Nigar Sekercioglu, Joycelyne Efua Ewusie, Lehana Thabane, Jason W. Busse, Noori Akhtar-Danesh, Alfonso Iorio, Tetsuya Isayama, Juan Pablo Díaz Martínez, Ivan D. Florez & Gordon H. Guyatt

  2. Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada

    Alfonso Iorio & Gordon H. Guyatt

  3. The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada

    Jason W. Busse

  4. Department of Anesthesia, McMaster University, Hamilton, ON, Canada

    Jason W. Busse

  5. Department of Pediatrics and Anesthesia, McMaster University, Hamilton, ON, Canada

    Lehana Thabane

  6. Centre for Evaluation of Medicine, St Joseph’s Healthcare—Hamilton, Hamilton, ON, Canada

    Lehana Thabane

  7. Biostatistics Unit, Father Sean O’Sullivan Research Centre, St Joseph’s Healthcare, 3rd Floor, Martha Wing, Room H-325, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada

    Lehana Thabane

  8. Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada

    Lehana Thabane

  9. Division of Pediatric Endocrinology, King Saud University, Riyadh, Saudi Arabia

    Reem Al-Khalifah & Lehana Thabane

  10. Nephrology Department, University of Sao Paulo School of Medicine, São Paulo, Brazil

    Rosilene M. Elias

  11. Department of Pediatrics, University of Antioquia, Medellin, Colombia

    Ivan D. Florez

Authors
  1. Nigar Sekercioglu
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  2. Reem Al-Khalifah
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Correspondence to Nigar Sekercioglu.

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Sekercioglu, N., Al-Khalifah, R., Ewusie, J.E. et al. A critical appraisal of chronic kidney disease mineral and bone disorders clinical practice guidelines using the AGREE II instrument. Int Urol Nephrol 49, 273–284 (2017). https://doi.org/10.1007/s11255-016-1436-3

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