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Evaluation of the methodological quality of two contradictory guidelines recently published by the Haute autorité de

Joseph Watine1, Julien Wils2, Christine Augereau3

  • 1Laboratoire de biologie polyvalente, Hôpital général, Villefranche-de-Rouergue, France.

Annales De Biologie Clinique
|January 31, 2017
PubMed

Insights

Two French guidelines on vitamin D testing in chronic kidney disease patients contradict recommendations. A quality assessment suggests the 2013 guideline is more rigorously developed and has higher editorial independence than the 2012 guideline.

Area of Science:

  • Nephrology
  • Clinical Practice Guidelines
  • Health Technology Assessment

Background:

  • Two conflicting guidelines from France's Haute autorité de santé (HAS) exist regarding vitamin D testing in chronic kidney disease (CKD).
  • The 2012 guideline recommended annual vitamin D testing for all CKD patients.
  • The 2013 guideline restricted this testing to post-kidney transplant ambulatory follow-up.

Purpose of the Study:

  • To evaluate the methodological quality of the 2012 and 2013 HAS guidelines.
  • To compare the development rigor and editorial independence of both guidelines using the AGREE instrument.

Main Methods:

  • Comparative evaluation of two clinical practice guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument.
  • Analysis focused on guideline development rigor (domain 3) and editorial independence (domain 6).

Main Results:

  • The 2013 guideline scored higher in development rigor (57%) and editorial independence (56%) compared to the 2012 guideline (24% and 25%, respectively).
  • Despite higher scores, the AGREE tool's subjective value and identified shortcomings in both guidelines raise concerns.

Conclusions:

  • The methods used to develop both HAS guidelines are deemed too uncertain for unconditional use, particularly the 2012 guideline.
  • Recommendations from the 2013 guideline may hold higher validity due to more rigorous development, but caution is still advised.

Keywords:
AGREE qualityHaute autorité de santéclinical practice guidelinesrecommendationsvitamin D

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