Evidence-Based Clinical Practice Guidelines for the Assessment and Management of Chronic Kidney Disease: A Systematic Review and Quality Assessment Using the AGREE II Instrument

Clinical practice guidelines (CPGs) based on evidence and expert opinions ensure that patients with chronic kidney disease (CKD) receive the most up to date care. We aimed to assess and evaluate the most recent and approved international CPGs and compare them via the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Four independent reviewers appraised the selected guidelines with the AGREE II instrument. We considered five eligible CPGs for critical appraisal: the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) CPGs for CKD, the National Institute for Health and Care Excellence (NICE) guidelines for assessing and managing CKD, the Academy of Nutrition and Dietetics’ CKD evidence-based nutrition practice guidelines, the CPGs of the Ministry of Public Health in Qatar (MOPH/QA), and the Scottish Intercollegiate Guidelines Network’s guidelines for the diagnosis and management of CKD. The overall assessments of three CPGs (NICE, NKF-K/DOQI, and MOPH/QA) scored greater than 85%; the results were congruent with higher scores in the six AGREE II domains: 80%, 67%, and 86% for Domain 3; 47%, 43%, and 86% for Domain 5; and 60%, 48%, and 86% for Domain 6, respectively. Generally, the clinical recommendations were significantly better for the NICE CPGs. All evidence-based CPGs had relatively low methodological quality. The NICE CPGs demonstrated the highest quality, followed by the MOPH/QA and NKF-K/DOQI CPGs, and all five CPGs were recommended for use in practice but with improvements. Saudi Arabia has to formulate its own national CPGs for the diagnosis and management of CKD based on those published by the NICE.