Identification and Prioritization of Canadian Society of Nephrology Clinical Practice Guideline Topics

Nephrology clinical practice guideline topics are routinely determined by clinicians and researchers, without extensive engagement of people with lived experience (PWLE) of kidney disease and their caregivers. The Canadian Society of Nephrology (CSN) Clinical Practice Guidelines Committee (CPGC) completed this modified Delphi study to incorporate diverse stakeholder perspectives in identifying and prioritizing future guideline topics.

We recruited nephrology clinicians, researchers, PWLE of kidney disease or their caregivers for this study. We collated literature-derived guideline topics from international and national guideline organizations that had relevance to nephrology, in addition to suggestions from participants. Consenting participants were taken through a 3 round Delphi survey process, where items were ranked on a 9-point Likert scale in terms of their importance. Based on predetermined consensus criteria, items were accepted as a priority or excluded from further consideration. We ranked the prioritized topics and compared the median ranking between clinicians or researchers and PWLE in the round where consensus was reached.

Of the 85 consenting participants, 76 to 78 completed each Delphi round. From the initial list of 100 topics for consideration, 12 were priorities. All stakeholder groups felt it was important for PWLE to be included in topic prioritization and guideline development. The 3 most highly prioritized topics were de novo guidelines on novel therapeutics to prevent or slow progression of chronic kidney disease (CKD), recommendations for primary care, and patient-oriented guidelines on diet and exercise in kidney disease. There were no statistical differences in the median ranking between stakeholder groups (P > 0.05).

This study will inform the future nephrology guidelines and commentaries developed by the CSN.