Trial-based guidelines and chronic kidney disease
Are Trial-based clinical practice guidelines possible in chronic kidney disease?
Tong A, Campbell D, Craig JC Nephrology 2007; 12 Suppl2:A41 [Presented at the 43rd Australian and New Zealand Society of Nephrology Annual Scientific Meeting, [ANZSN] 2007 Sept 8–12; Gold Coast, Australia.]
Guidelines International Network conference in Toronto, Canada in August 2007.
Ideally, clinical practice guidelines are supported by high quality evidence but trials in chronic kidney disease are relatively few in number compared with other specialties in internal medicine.
Allison Tong and co-authors assessed the proportion of CARI Guideline Recommendations supported by high quality evidence compared with Suggestions for Clinical Care, based on low or missing evidence. All CARI Guidelines published from 2004-2006 were reviewed.
Analysis of the data showed that:
- 43.4% of guideline subtopics were supported by at least Level I or II evidence (i.e. systematic review, randomised controlled trial);
- 34.1% were supported by Level III or IV evidence (i.e. cohort studies, case control studies etc.);
- 22.5% were not supported by any trial evidence.
This applied across the 3 topic areas; chronic kidney disease, dialysis and transplantation. The conclusion was that there is a need for more high quality RCT evidence in nephrology, which will in turn lead to the development of more valid clinical practice guidelines.