A critical appraisal of chronic kidney disease mineral and bone disorders clinical practice guidelines using the AGREE II instrument.
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
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.
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. nigars2003@yahoo.com.
Nigar
N
Sekercioglu
Division of Pediatric Endocrinology, King Saud University, Riyadh, Saudi Arabia.
Reem
R
Al-Khalifah
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
Joycelyne Efua
JE
Ewusie
Nephrology Department, University of Sao Paulo School of Medicine, São Paulo, Brazil.
Rosilene M
RM
Elias
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.|Department of Pediatrics and Anesthesia, McMaster University, Hamilton, ON, Canada.|Centre for Evaluation of Medicine, St Joseph's Healthcare-Hamilton, Hamilton, ON, Canada.|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.|Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada.|Division of Pediatric Endocrinology, King Saud University, Riyadh, Saudi Arabia.
Lehana
L
Thabane
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.|The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada.|Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
Jason W
JW
Busse
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
Noori
N
Akhtar-Danesh
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.|Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
Alfonso
A
Iorio
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
Tetsuya
T
Isayama
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
Juan Pablo Díaz
JP
Martínez
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.|Department of Pediatrics, University of Antioquia, Medellin, Colombia.
Ivan D
ID
Florez
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.|Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
Gordon H
GH
Guyatt
D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000175:diagnosis / Q000628:therapy; D019468:Disease Management; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*
Advancing guideline development; Chronic kidney disease; Clinical practice guidelines; Mineral and bone disorder; Reporting and evaluation in health care instrument