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Prevention, detection and management of early chronic kidney disease: A systematic review of clinical practice guidelines
Author(s) -
LopezVargas Pamela A,
Tong Allison,
Sureshkumar Premala,
Johnson David W,
Craig Jonathan C
Publication year - 2013
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12119
Subject(s) - medicine , guideline , proteinuria , renal function , creatinine , kidney disease , albuminuria , urology , family medicine , intensive care medicine , kidney , pathology
Aim In response to the increase in C hronic K idney D isease ( CKD ) worldwide, several professional organizations have developed clinical practice guidelines to manage and prevent its progression. This study aims to compare the scope, content and consistency of published guidelines on CKD stages I – III . Methods Electronic databases of the medical literature, guideline organizations, and the websites of nephrology societies were searched to N ovember 2011. The A ppraisal of G uidelines for R esearch and E valuation ( AGREE ) II instrument and textual synthesis was used to appraise and compare recommendations. Results One consensus statement and 15 guidelines were identified and included. Methodological rigour across guidelines was variable, with average domain scores ranging from 24% to 95%. For detection of CKD , all guidelines recommended estimated glomerular filtration rate measurement, some also recommended serum creatinine and dipstick urinalysis. The recommended protein and albumin creatinine ratios and proteinuria definition thresholds varied (>150–300 mg/day to >500 mg/day). Blood pressure targets ranged (<125/75 to <140/90 mmHg). Angiotensin converting enzyme inhibitor and angiotensin receptor blockers were recommended for hypertension, as combined or as monotherapy. Protein intake recommendations varied (no restriction or 0.75 g/kg per day−1.0 g/kg per day). Salt intake of 6 g/day was recommended by most. Psychosocial support and education were recommended by few but specific strategies were absent. Conclusion CKD guidelines were consistent in scope but were variable with respect to their recommendations, coverage and methodological quality. To promote effective primary and secondary prevention of CKD , regularly updated guidelines that are based on the best available evidence and augmented with healthcare context‐specific strategies for implementation are warranted.