Summary of the KDIGO Guideline on Anemia
The Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guideline for anemia in chronic kidney disease (CKD) is designed to assist health-care providers in treating CKD patients with anemia. A guideline is not intended to define a standard of care, and should not be construed as one, nor should it be interpreted as prescribing an exclusive course of management. It is intended to provide information and to allow the practitioner to make an informed decision, based on evidence and expert judgment. Every health-care professional making use of these recommendations is responsible for evaluating the appropriateness of applying them in any particular clinical situation. Owing to the general nature of a guideline, it is sometimes difficult to translate it to an individual patient's condition. As the primary goal is to improve patient care, we have decided to focus on practical clinical aspects of the KDIGO anemia guideline.
The Kidney Disease Improving Global Outcomes (KDIGO) Clinical practice guideline (CPG) for anemia in chronic kidney disease (CKD) is based upon systematic literature searches last conducted in October 2010, supplemented with additional evidence through March 2012. It is designed to provide information and assist decision making. The potential benefits of CPGs are many. By providing clear recommendation based on current evidence, CPGs can improve the quality of clinical decisions. Evidence-based guidelines support interventions that are of proven benefit while documenting the quality of the supporting data. Further, interventions unsupported by good science have also been reviewed, and call attention to ineffective or even harmful practices. On the flip side, there is also the possibility that CPGs could have negative consequences. In the situation in which only a few studies are of high enough quality, many recommendations made by guideline committees are subjective and 'opinion based'. Importantly, despite good-quality data, a recommendation may not be suitable for a particular patient. Finally, applications of nonmedical values combined with intense pressures on health-care provision can create an environment for guideline misuse.
Although CPGs have been shown to improve the quality of care, whether they achieve this in daily practice is less clear. In an analysis of 59 CPG evaluations covering a wide range of clinical activities, all but four detected statistically significant improvements in the process of medical care. Moreover, all except 2 of the 11 that also measured the outcome of care reported significant improvements in outcome. Guidelines that are likely to change medical practice have a few characteristics in common. First, they are likely to be developed internally by the very physicians who are going to use them. Second, appropriate development, dissemination, and implementation strategies are adopted during their introduction. Last, implementation strategies that are operative within the doctor–patient consultation are more likely to be effective.
Abstract and Introduction
Abstract
The Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guideline for anemia in chronic kidney disease (CKD) is designed to assist health-care providers in treating CKD patients with anemia. A guideline is not intended to define a standard of care, and should not be construed as one, nor should it be interpreted as prescribing an exclusive course of management. It is intended to provide information and to allow the practitioner to make an informed decision, based on evidence and expert judgment. Every health-care professional making use of these recommendations is responsible for evaluating the appropriateness of applying them in any particular clinical situation. Owing to the general nature of a guideline, it is sometimes difficult to translate it to an individual patient's condition. As the primary goal is to improve patient care, we have decided to focus on practical clinical aspects of the KDIGO anemia guideline.
Introduction
The Kidney Disease Improving Global Outcomes (KDIGO) Clinical practice guideline (CPG) for anemia in chronic kidney disease (CKD) is based upon systematic literature searches last conducted in October 2010, supplemented with additional evidence through March 2012. It is designed to provide information and assist decision making. The potential benefits of CPGs are many. By providing clear recommendation based on current evidence, CPGs can improve the quality of clinical decisions. Evidence-based guidelines support interventions that are of proven benefit while documenting the quality of the supporting data. Further, interventions unsupported by good science have also been reviewed, and call attention to ineffective or even harmful practices. On the flip side, there is also the possibility that CPGs could have negative consequences. In the situation in which only a few studies are of high enough quality, many recommendations made by guideline committees are subjective and 'opinion based'. Importantly, despite good-quality data, a recommendation may not be suitable for a particular patient. Finally, applications of nonmedical values combined with intense pressures on health-care provision can create an environment for guideline misuse.
Although CPGs have been shown to improve the quality of care, whether they achieve this in daily practice is less clear. In an analysis of 59 CPG evaluations covering a wide range of clinical activities, all but four detected statistically significant improvements in the process of medical care. Moreover, all except 2 of the 11 that also measured the outcome of care reported significant improvements in outcome. Guidelines that are likely to change medical practice have a few characteristics in common. First, they are likely to be developed internally by the very physicians who are going to use them. Second, appropriate development, dissemination, and implementation strategies are adopted during their introduction. Last, implementation strategies that are operative within the doctor–patient consultation are more likely to be effective.