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Caring for Australians and New Zealanders With Kidney Impairment Guidelines: Rapid Development of Urate Lowering
Isabelle Kitty Stanley1,2, Richard K S Phoon3,4, Nigel D Toussaint5,6
1Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia.
Introduction:
The slow transformation of new research findings into clinical guidelines is a barrier to providing evidence-based care. The Caring for Australians and New Zealanders with Kidney Impairment (CARI) guidelines are developing models to improve guideline production, one methodology involves more functional concordance between trial groups, such as the Australian Kidney Trials Network (AKTN) and CARI. The objective of this project was to rapidly produce an evidence-based guideline on urate-lowering therapy in patients with chronic kidney disease (CKD), in response to new clinical trial publications on the topic by the AKTN.
Methods:
To produce a guideline as rapidly as possible, an existing systematic review was utilized as the evidence base, and then updated with the inclusion of clinical trials that had been published subsequently. A Work Group was convened to review the evidence and compose an appropriate guideline using CARI/GRADE methodology. The group met 3 times over 45 days to formulate the guideline.
Results:
The result was a strong recommendation against the use urate-lowering therapies in individuals with CKD (not receiving dialysis) and asymptomatic hyperuricemia. The process of identifying an appropriate existing systematic review, updating the literature search, and synthesizing the evidence, was done by 2 individuals over 15 days. The Work Group was formulated and composed the guideline over 45 days. In all, a new guideline incorporating the most up-to-date evidence was formulated in 60 days.
Conclusion:
This method of guideline development represents a potentially new way of releasing guidelines that encapsulates all available evidence in a time-efficient manner.
Insights
This study developed a rapid guideline for urate-lowering therapy in chronic kidney disease (CKD) patients. It strongly recommends against using these therapies for asymptomatic hyperuricemia in non-dialysis CKD individuals.
Area of Science:
- Nephrology
- Clinical Guideline Development
- Evidence-Based Medicine
Background:
- Translating research into clinical guidelines is slow, hindering evidence-based care.
- The Caring for Australians and New Zealanders with Kidney Impairment (CARI) guidelines aim to improve guideline production efficiency.
- This project focused on rapidly creating a guideline for urate-lowering therapy in chronic kidney disease (CKD) based on new Australian Kidney Trials Network (AKTN) publications.
Purpose of the Study:
- To rapidly develop an evidence-based clinical guideline on urate-lowering therapy for patients with chronic kidney disease (CKD).
- To address new clinical trial findings from the Australian Kidney Trials Network (AKTN) concerning urate-lowering therapies in CKD.
Main Methods:
- Utilized an existing systematic review as the evidence base, updated with subsequent clinical trial publications.
- Convened a Work Group to review evidence and formulate the guideline using CARI/GRADE methodology over 45 days.
- Employed a streamlined process involving two individuals for literature review and evidence synthesis within 15 days.
Main Results:
- A strong recommendation was issued against the use of urate-lowering therapies in individuals with CKD (not on dialysis) and asymptomatic hyperuricemia.
- The guideline development process, from initial review to final composition, was completed in 60 days.
- This rapid approach successfully incorporated the most up-to-date evidence into clinical recommendations.
Conclusions:
- The developed method offers a time-efficient approach to guideline creation, ensuring all available evidence is encapsulated.
- This model potentially represents a novel strategy for timely guideline dissemination in clinical practice.
- Rapid guideline development can accelerate the implementation of evidence-based care for conditions like CKD.
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