Co-creation in developing international guidelines for the management of kidney disease

Article type
Authors
Tunnicliffe D1, Howell M1, Cheung M2, Palmer S3, Strippoli G4, Tonelli M5, Vandvik PO6, Tong A1, Craig J7
1The University of Sydney
2Kidney Disease: Improving Global Outcomes
3University of Otago
4University of Bari
5University of Calgary
6University of Oslo
7Flinders University
Abstract
Background: The exponential increase in scientific literature has challenged traditional models of clinical practice guideline development in nephrology. Undertaking evidence synthesis that adheres to international standards for guideline development is resource-intensive and methodologically challenging. Improved collaboration between existing organisations with appropriate expertise is required for the development of guidelines on the diagnosis, monitoring, and treatment of kidney disease.

Objectives: To describe the collaboration between Cochrane Kidney and Transplant (CKT), Standardised Outcomes in Nephrology (SONG) Initiative, Kidney Disease: Improving Global Outcomes (KDIGO), and Making Grade the Irresistible Choice (MAGIC) to develop international guidelines for the management of kidney disease.

Methods: KDIGO has engaged CKT as the evidence review team for two guideline updates (KDIGO Glomerulonephritis Guideline; KDIGO Management of Blood Pressure in Chronic Kidney Disease Guideline) and one new guideline (KDIGO Management of Diabetes in Chronic Kidney Disease). CKT with KDIGO developed protocols that mapped PICO questions, relevant to the guideline topic to existing Cochrane reviews. SONG core outcomes were identified as critical and important outcomes in guideline development. The CKT Register of Studies was searched to update reviews with input from review authors as necessary, and new systematic reviews were undertaken as required. Summary of findings tables was developed and presented in MAGICapp to the guideline Work Group, to inform the development of guideline recommendations.

Results: This collaboration between partners had led to 23 Cochrane reviews being updated, two new Cochrane reviews, and 27 systematic reviews of which there was no Cochrane review available. The clinical practice guidelines are close to publication, with two of the three guidelines having undergone a public comment period. The partnership has reduced duplication of effort across organisations and ensured that guidelines incorporate core outcomes, that matter to consumers in the evidence review process. The use of Cochrane systematic reviews and MAGICapp has improved the transparency in translation from evidence to recommendations and will allow for the rapid updating of guidelines in the future.

Conclusions: Developing collaborations in guideline development and utilising existing Cochrane reviews has improved efficiency for all organisations and developed new opportunities for guidelines to adhere to international best-practice and include patient-important outcomes, with the potential for rapid updating.

Patient or healthcare consumer involvement: The inclusion of Standardised Outcomes in Nephrology (SONG) as critical and important outcomes for guideline development ensured that patient and caregiver priorities were being addressed were being addressed. Additionally, in the diabetes guideline, patient and caregivers were involved in the guideline work group.