Title

Chronic Kidney Disease–Mineral and Bone Disorder

Authoring Organization

Kidney Disease Improving Global Outcomes

Publication Month/Year

July 1, 2017

Last Updated Month/Year

June 9, 2022

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Ambulatory, Hospital, Operating and recovery room, Outpatient

Intended Users

Dietician nutritionist, nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Prevention, Treatment

Diseases/Conditions (MeSH)

D007676 - Kidney Failure, Chronic, D007674 - Kidney Diseases

Keywords

chronic kidney disease, bone mineral density, hyperparathyroidism

Supplemental Methodology Resources

Data Supplement, Evidence Tables

Methodology

Number of Source Documents
173
Literature Search Start Date
September 1, 2015
Literature Search End Date
February 28, 2017
Description of External Review Process
Yes. The process of peer review included an external review by the public to ensure widespread input from numerous stakeholders, including patients, experts, and industry and national organizations.
Description of Public Comment Process
Yes. The process of peer review included an external review by the public to ensure widespread input from numerous stakeholders, including patients, experts, and industry and national organizations.
Specialties Involved
Endocrinology, Family Medicine, Geriatric Medicine, Internal Medicine General, Nephrology
Description of Systematic Review
The Work Group Co-Chairs and the ERT defined the overall scope and goals of the guideline (including a list of critical and important interventions and outcomes) and then drafted a preliminary list of topics and key clinical questions. The list of research and recommendation topics was based on the original KDIGO guideline which the ERT also had helped to develop (when it was based at The Johns Hopkins University in Baltimore, Maryland). The Work Group and ERT further developed and refined each topic and its eligibility criteria, literature search strategies, and data extraction
List of Questions
Refer to Full Text
Description of Study Criteria
Yes. Inclusion and exclusion criteria. With input from the Work Group, the ERT defined the eligibility criteria a priori. The eligibility criteria for all studies were: (i) original data published in English, (ii) followed up at least 10 patients with CKD for at least 6 months, and (iii) addressed 1 of the research questions. The minimum mean duration of follow-up of 6 months was chosen on the basis of clinical reasoning, accounting for the hypothetical mechanisms of action. For treatments of interest, the proposed effects on patient-centered outcomes require long-term exposure and typically would not be evident before several months of follow-up. The question-specific eligibility criteria are provided in Table 3, and the overall search yield for the guideline systematic review is summarized in Supplementary Appendix B. Two reviewers independently screened titles and abstracts and full-text articles for inclusion. Differences regarding inclusion were resolved through consensus adjudication. Any study not meeting the inclusion criteria could be cited in the narrative but was not considered part of the body of evidence for a particular recommendation.
Description of Search Strategy
Search strategy. The ERT searched MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL) for the date range of December 2006 through September 2015. The December 2006 date provided the recommended 1-year overlap with the end of the previous search.164 The search yield was also supplemented by articles provided by the Work Group members through February 2017. The search strategy included MeSH and text terms for CKD and the interventions and markers of interest (Supplementary Appendix A) and was limited to the English language. The ERT also reviewed the list of references that were suggested during the Controversies Conference. All studies that had been included in the prior guideline were rereviewed to ensure that they met the eligibility criteria
Description of Study Selection
Yes. Two reviewers independently screened titles and abstracts and full-text articles for inclusion. Differences regarding inclusion were resolved through consensus adjudication. Any study not meeting the inclusion criteria could be cited in the narrative but was not considered part of the body of evidence for a particular recommendation.
Description of Evidence Analysis Methods
Yes. Data extraction The ERT modified the online supplementary tables from the prior guideline. One reviewer abstracted data directly into the modified tables, and a second reviewer confirmed the data abstraction. The ERT abstracted data on general study characteristics, participant characteristics, interventions and co-interventions, and outcome measures, including measures of variability. Two reviewers independently assessed individual study quality using the Cochrane Collaboration’s tool for assessing risk of bias for RCTs and using the Quality in Prognosis Studies tool for observational studies.
Description of Evidence Grading
Yes. Refer to Table 5, page 47. Grading the quality of evidence for each outcome The ‘quality of a body of evidence’ refers to the extent to which our confidence in an estimate of effect is sufficient to support a particular recommendation. Following GRADE, the quality of a body of evidence pertaining to a particular outcome of interest is initially categorized on the basis of study design. For questions of interventions, the initial quality grade is “high” if the body of evidence consists of RCTs, “low” if it consists of observational studies, or “very low” if it consists of studies of other study designs. For questions of interventions, the Work Group graded only RCTs. The grade for the quality of evidence for each intervention–outcome pair was then decreased if there were serious limitations to the methodological quality of the aggregate of studies; if there were important inconsistencies in the results across studies; if there was uncertainty about the directness of evidence including a limited applicability of findings to the population of interest; if the data were imprecise or sparse; or if there was thought to be a high likelihood of bias. The final grade for the quality of evidence for an intervention–outcome pair could be 1 of the following 4 grades: “high,” “moderate,” “low,” or “very low” (Table 4).
Description of Recommendation Grading
Yes. Refer to Table 7 page 47. KDIGO uses a GRADE Methodology. Level 1: “We Recommend.” Clinicians: most patients should receive the recommended course of action. Level 2 Conditional Recommendation: “We Suggest.” Clinicians: Different choices will be appropriate for different patients. Each patient needs help to arrive at a management decision consistent with her or his values and preferences.
Description of Funding Source
Yes. Johns Hopkins University was contracted as the ERT. This guideline is funded by KDIGO. Financial disclosures of Work Group members are published in Biographic and Disclosure Information section of the guideline.
Company/Author Disclosures
Yes. Financial disclosures of Work Group members are published in Biographic and Disclosure Information section of the guideline.
Percentage of Authors Reporting COI
100