Priorities for Evidence-Based CKD Guidance Using Delphi Methods

Topic selection for systematic reviews and clinical practice guidelines often lacks transparent prioritization and meaningful community input. We aimed to identify shared priorities between people with lived experience of chronic kidney disease (CKD) and health-professionals to align evidence-based care with patient-clinician needs.

We conducted a 3-round modified-Delphi survey across the following 4 modules: nondialysis CKD, peritoneal dialysis (PD), hemodialysis (HD), and transplantation. Round-1 participants rated (9-point Likert) and ranked (Best-Worst Scaling [BWS]) broad topics. Priority topics were refined into subtopics and rated in round-2; round-3 re-rated and ranked priority subtopics. Topic progression criteria included Likert thresholds, agreement (scores 7-9), and BWS scores (estimated via multinomial logistic regression), with data summarized descriptively (mean ± SD, % agreement).

Participation was 102 in round-1 (27% consumers) increasing to 613 in round-3 (71% consumers). Round-1 priority topics were as follows: Evaluation and management of CKD (8.09 ± 1.11, 93%), Infection and peritonitis management (PD; 7.98 ± 1.41, 88%), Cardiovascular disease management (HD; 7.96 ± 1.33, 89%), and Transplant rejection (8.36 ± 1.05, 96%). Across rounds 2 and 3, the prioritized subtopics were as follows: Treatment to slow CKD progression (6.37 ± 2.53, 56%), Maintenance of residual kidney function (PD; (7.19 ± 2.10, 96%), Volume control (HD; 7.15 ± 2.12, 75%), and Management of medication side-effects (transplantation; 6.65 ± 2.53, 65%). Where consumer-clinician differences emerged, consumers prioritized daily-life impacts (symptoms/side-effects, psychosocial support, infection prevention, and education), whereas clinicians emphasized care delivery (protocols, eligibility, and monitoring).

This multistakeholder prioritization distilled broad kidney care domains into actionable subtopics, centered around slowing CKD progression and improving symptoms during kidney replacement therapy, providing targeted systematic reviews and guideline updates supporting shared decision-making in CKD.