title: The Canadian Society of Nephrology methods in developing and adapting clinical practice guidelines: a review.
abstract: BACKGROUND
  The Canadian Society of Nephrology (CSN) was established to promote the highest quality of care for patients with renal diseases and to encourage research related to the kidney and its disorders. The CSN Clinical Practice Guideline (CPG) Committee develops guidelines with clear recommendations to influence physicians' practice and improve the health of patients with kidney disease in Canada.
  
  
  METHODS
  In this review we describe the CSN process in prioritizing CPGs topics. We document the CSN experience using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We then detail the CSN process in developing de novo CPGs and in adapting existing CPGs and developing accompanying commentaries. We also discuss challenges faced during this process and suggest solutions. Furthermore, we summarize the CSN effort in disseminating and implementing their guidelines. Additionally, we describe recent development and partnerships that allow evaluation of the effect of the CSN guidelines and commentaries.
  
  
  CONCLUSIONS
  The CSN follows a comprehensive process in identifying priority areas to be addressed in CPGs. In 2010, the CSN adopted GRADE, which enhanced the rigor and transparency of guideline development. This process focuses on systematically identifying best available evidence and carefully assessing its quality, balancing benefits and harms, considering patients' and societies' values and preferences, and when possible considering resource implications. Recent partnership allows wider dissemination and implementation among end users and evaluation of the effects of CPG and commentaries on the health of Canadians.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, CanadaHSC Room 2C15 1280 Main Street West, Hamilton, Ontario ON L8S 4 K1 Canada ; Department of Internal Medicine, University of Missouri, Kansas City, USA.
authors.forename: Reem A
authors.initials: RA
authors.lastname: Mustafa
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, British Columbia Canada.
authors.forename: Adeera
authors.initials: A
authors.lastname: Levin
authors.affiliation: Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, Ontario Canada.
authors.forename: Ayub
authors.initials: A
authors.lastname: Akbari
authors.affiliation: Departments of Pediatrics and Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec Canada.
authors.forename: Bethany J
authors.initials: BJ
authors.lastname: Foster
authors.affiliation: Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, Ontario Canada.
authors.forename: Deborah
authors.initials: D
authors.lastname: Zimmerman
authors.affiliation: Li Ka Shing Knowledge Institute, Keenan Research Centre, St. Michael's Hospital, and Humber River Hospital, Toronto, Ontario Canada.
authors.forename: Gihad E
authors.initials: GE
authors.lastname: Nesrallah
authors.affiliation: Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario Canada.
authors.forename: Greg A
authors.initials: GA
authors.lastname: Knoll
authors.affiliation: Department of Medicine, Nephrology Division, Hôpital du Sacré-Cœur de Montréal, University of Montreal, Montreal, Quebec Canada.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Rioux
authors.affiliation: Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan Canada.
authors.forename: Jim
authors.initials: J
authors.lastname: Barton
authors.affiliation: Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, Ontario Canada.
authors.forename: Marcel
authors.initials: M
authors.lastname: Ruzicka
authors.affiliation: Department of Medicine, Western University, London, Ontario Canada.
authors.forename: Norman
authors.initials: N
authors.lastname: Muirhead
authors.affiliation: Department of Medicine, Western University, London, Ontario Canada.
authors.forename: Louise
authors.initials: L
authors.lastname: Moist
authors.affiliation: Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta Canada.
authors.forename: Neesh
authors.initials: N
authors.lastname: Pannu
authors.affiliation: Department of Medicine, Li Ka Shing Knowledge Institute, Keenan Research Centre, St. Michael's Hospital, University of Toronto, Toronto, Ontario Canada.
authors.forename: Phil
authors.initials: P
authors.lastname: McFarlane
authors.affiliation: Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: Klarenbach
authors.affiliation: Department of Pediatrics, University of Calgary, Calgary, Alberta Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Samuel
authors.affiliation: Department of Medicine, Western University, London, Ontario Canada.
authors.forename: William F
authors.initials: WF
authors.lastname: Clark
authors.affiliation: Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta Canada.
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Hemmelgarn
keywords: Canadian Society of Nephrology; Clinical practice guideline; Commentary; GRADE; Guidelines development