Article type
Abstract
"Background
Translating new scientific evidence into clinical practice in chronic kidney disease is challenged by the rapid proliferation of scientific literature, leading to outdated clinical guidelines and systematic reviews. The priorities of the kidney health community are needed to determine what clinical guidance is needed and maximise limited resources.
Objectives
We aim to identify the currency of kidney research questions covered in high-quality systematic reviews and guideline recommendations to inform a multistakeholder prioritisation process. We aim to identify the priorities of the kidney health community for systematic reviews and clinical guidelines.
Methods
We extracted all chronic kidney disease clinical questions covered in guidelines and Cochrane systematic reviews. The list of topics was grouped across chronic kidney disease stages (pre-dialysis, dialysis, transplantation) by an expert Working Group to inform a multi-round Delphi survey. Health professionals were invited to participate via professional networks and people with lived experience by consumer bodies in an online three-round Delphi survey. Participants rated the importance of research questions using 9-point Likert and Best-Worst scales. Topics selected in round one of the surveys was linked to specific clinical questions that were ranked in round 2 with an opportunity to provide justification for the ranking. The clinical questions were re-ranked again in round 3. We analysed data using descriptive statistics and thematic analysis for text-responses.
Results
We linked 178 relevant Cochrane reviews to 79 guidelines with over 50% of the linked guidelines >5 years old. 106 participants completed the Delphi survey, 30% from consumers. In pre-dialysis, diagnosis and evaluation emerged as the top priority, while kidney stones were considered the least urgent for updated guidance. In other modules, transplant rejection; infection and peritonitis in peritoneal dialysis; and cardiovascular disease (CVD) in hemodialysis, were highlighted as top priorities. CVD management in CKD was the sole topic with equal importance among clinicians and consumers.
Conclusions
Most of the research questions covered in chronic kidney disease guidelines are out of date. The priorities of consumers and clinicians for up-to-date evidence-based guidance often vary but a multistakeholder Delphi can ensure limited resources are maximised for clinical care in chronic kidney disease.
Translating new scientific evidence into clinical practice in chronic kidney disease is challenged by the rapid proliferation of scientific literature, leading to outdated clinical guidelines and systematic reviews. The priorities of the kidney health community are needed to determine what clinical guidance is needed and maximise limited resources.
Objectives
We aim to identify the currency of kidney research questions covered in high-quality systematic reviews and guideline recommendations to inform a multistakeholder prioritisation process. We aim to identify the priorities of the kidney health community for systematic reviews and clinical guidelines.
Methods
We extracted all chronic kidney disease clinical questions covered in guidelines and Cochrane systematic reviews. The list of topics was grouped across chronic kidney disease stages (pre-dialysis, dialysis, transplantation) by an expert Working Group to inform a multi-round Delphi survey. Health professionals were invited to participate via professional networks and people with lived experience by consumer bodies in an online three-round Delphi survey. Participants rated the importance of research questions using 9-point Likert and Best-Worst scales. Topics selected in round one of the surveys was linked to specific clinical questions that were ranked in round 2 with an opportunity to provide justification for the ranking. The clinical questions were re-ranked again in round 3. We analysed data using descriptive statistics and thematic analysis for text-responses.
Results
We linked 178 relevant Cochrane reviews to 79 guidelines with over 50% of the linked guidelines >5 years old. 106 participants completed the Delphi survey, 30% from consumers. In pre-dialysis, diagnosis and evaluation emerged as the top priority, while kidney stones were considered the least urgent for updated guidance. In other modules, transplant rejection; infection and peritonitis in peritoneal dialysis; and cardiovascular disease (CVD) in hemodialysis, were highlighted as top priorities. CVD management in CKD was the sole topic with equal importance among clinicians and consumers.
Conclusions
Most of the research questions covered in chronic kidney disease guidelines are out of date. The priorities of consumers and clinicians for up-to-date evidence-based guidance often vary but a multistakeholder Delphi can ensure limited resources are maximised for clinical care in chronic kidney disease.