Introduction
Methods
General approach
Preliminary categorization and identification of topics for CER studies
Selection of CKD community stakeholder representatives
Organization Types | Clinical Expertise |
---|---|
·Patient Advocacy Groups (2) | ·Primary Care (Family Practice and Internal Medicine) |
·Health Professional Societies (2) | ·Adult Nephrology |
·Private Healthcare Insurer (1) | ·Pediatric Nephrology |
·Governmental Healthcare Insurer (2) | ·Endocrinology |
·National Institutes of Health (2) | |
Not representing an organization (2) |
Community Stakeholder Engagement
Assessment of CER systematic review feasibility
Findings
Final categorization and list of potential topics for CER studies
Topic | Example Question* | |
---|---|---|
Prevention
| ||
1**
| Patient knowledge/education | What is the effectiveness of strategies to improve patient knowledge or awareness of CKD and CKD risk factors on decreasing CKD incidence? |
2
| Hypertension | What is the comparative effectiveness of hypertension management (pharmacologic and non-pharmacologic) on CKD incidence? |
3
| Diabetes control and prevention | What is the comparative effectiveness of diabetes management (pharmacologic and non-pharmacologic) on CKD incidence? |
4
| Patient Safety | What is the effectiveness of patient safety interventions on decreasing the incidence of acute kidney injury/CKD (i.e. exposure to contrast/dyes, nephrotoxins [NSAIDS])? |
5
| Smoking cessation and prevention | What is the comparative effectiveness of smoking cessation strategies on CKD incidence? |
6
| Lipid management | What is the comparative effectiveness of lipid management strategies on CKD incidence? |
7
| Vitamin D | What is the effectiveness of normalizing Vitamin D levels among deficient or insufficient patients in preventing CKD? |
8
| Obesity/Weight Management | What is the effectiveness of obesity/weight management interventions in decreasing CKD incidence? |
Detection
| ||
9
| Screening benefits and harms | What are the benefits and harms of screening versus usual detection of CKD? |
10
| Screening frequency | What is the optimal screening frequency in populations at high-risk of CKD incidence? |
11
| Classification | Which estimations of GFR accurately classify people as having CKD? Including the correct stage? |
12
| Automated estimated GFR reporting | Does automated estimated GFR reporting lead to changes in clinical management and outcomes (drugs/referral)? |
Progression
| ||
13
| Health Information Technology | What is the effectiveness of computer decision support for CKD management (including medication dosing) in slowing CKD progression? |
14
| Hyperuricemia | Is treatment of hyperuricemia an effective strategy for slowing CKD progression? |
15
| Inflammation | What is the comparative effectiveness of strategies to reduce markers of inflammation (i.e. C-reactive protein) in slowing CKD progression? |
16
| Provider awareness and guideline adherence | What is the effectiveness of strategies to improve provider awareness and adherence to guidelines on improving outcomes (progression) for patients with CKD? |
17
| Collaboration strategies | What is the effectiveness of strategies to increase collaboration in care (i.e. primary care/nephrology and team based approaches) of CKD patients in slowing CKD progression? |
18
| Diabetes management | What is the effectiveness and comparative effectiveness of diabetes management strategies (i.e. pharmacologic and behavioral strategies, therapeutic targets) in slowing CKD progression? |
19 | Vitamin D | Is vitamin D therapy effective in slowing CKD progression? |
20
| Hypertension | What is the comparative effectiveness of strategies to treat hypertension (i.e. target, medication combinations, behavioral strategies, lifestyle interventions) in slowing CKD progression? |
21
| Proteinuria | Is targeted therapy to reduce proteinuria (ie. optimal proteinuria target, specific therapies) effective in slowing CKD progression? |
22
| Patient safety | What is the effectiveness of patient safety interventions on slowing CKD progression? |
23
| Access to care | Is improved access to care (including primary or nephrology care) an effective mechanism for slowing CKD progression? |
24
| Cardiovascular disease | Are interventions to manage heart failure and coronary artery disease effective in slowing CKD progression? |
25
| Dietary strategies | What is the effectiveness or comparative effectiveness of dietary strategies in slowing CKD progression? |
26
| Congenital urologic disease | What is the effectiveness and comparative effectiveness of strategies to treat congenital urologic disease in slowing CKD progression? |
27
| Acute kidney injury | What is the comparative effectiveness of management strategies of AKI in slowing CKD progression? |
28
| Preparation for renal replacement therapy | What is the comparative of strategies (e.g., education, shared decision-making, fistula placement) to prepare patients for renal replacement therapy? |
29
| Metabolic acidosis | Is treatment of metabolic acidosis an effective strategy for slowing CKD progression? |
30
| Anemia | Is treatment of anemia an effective strategy for slowing CKD progression? |
31
| Dyslipidemia | Is treatment of dyslipidemia an effective strategy in slowing CKD progression? |
32
| Renovascular disease | Are renovascular interventions effective in slowing CKD progression? |
Complications
| ||
33
| Cardiovascular Disease (CVD) | What is the effectiveness or comparative effectiveness of strategies to prevent or treat CVD among patients with CKD? |
34
| Patient Educational Interventions | What is the effectiveness of patient educational interventions in reducing CKD complications? |
35
| Bone/Mineral Disease | What is the effectiveness or comparative effectiveness of strategies to screen, evaluate and treat bone/mineral disease among patients with CKD? |
36
| Hypertension | What is the effectiveness or comparative effectiveness of blood pressure management strategies among patients with CKD? |
37
| Inflammation | What is the comparative effectiveness of strategies to reduce markers of inflammation (i.e., CRP) in slowing CKD progression? |
38
| Nutrition/Growth | What is the effectiveness of strategies to prevent, evaluate, and treat poor growth and malnutrition among patients with CKD? |
39
| Health Information Technology | What is the effectiveness of computer decision support for CKD management in reducing complications? |
40
| Collaborative Care | What is the effectiveness of strategies to increase collaboration (i.e., primary care/nephrology and team based approaches) in care of CKD for reducing CKD complications? |
41
| Patient Safety | What is the effectiveness of patient safety interventions in reducing complications among CKD patients? |
42
| Patient Reported Outcomes | What is the effectiveness of interventions to improve patient reported CKD complications (i.e. symptoms, sexual dysfunction, quality of life)? |
43
| Anemia | What is the effectiveness or comparative effectiveness of strategies to screen, evaluate, and treat anemia in patients with CKD? |
44
| Acute Kidney Injury | What is the effectiveness or comparative effectiveness of strategies to prevent or treat acute kidney injury among patients with CKD? |
45
| Functional status | What is the effectiveness of strategies to evaluate and improve functional status (i.e. rehabilitation interventions) among patients with CKD? |
46
| Fluid management | What is the effectiveness or comparative effectiveness of treatment strategies for volume overload among patients with CKD? |
Final Stakeholder Prioritization of Topics for CER Studies
Topic | CKD Area | Rank*
| Feasibility | |||
---|---|---|---|---|---|---|
Systematic reviews | **Randomized controlled trials | |||||
Pharmacologic | Behavioral | †Priority population | ||||
Proteinuria | Progression | 1 | 9 | >100 | 20 | 0 |
Access to care | Progression | 2 | 1 | 2 | 2 | 2 |
Hypertension | Progression | 2 | 11 | 68 | 3 | 37 |
Screening benefits and harms | Detection | 3 | 1 | 0 | 0 | 0 |
Hypertension control | Prevention | 4 | 0 | 1 | 0 | 0 |
Patient knowledge/education | Prevention | 5 | 0 | 0 | 3 | 3 |
Diabetes control and prevention | Prevention | 6 | 2 | 18 | 3 | 23 |
Cardiovascular Disease | Complications | 7 | 3 | 40 | 0 | 5 |
Patient safety | Progression | 7 | 5 | 64 | 2 | 4 |
Health Information Technology | Progression | 8 | 0 | 5 | 1 | 0 |
Patient Safety | Prevention | 9 | 24 | 29 | 0 | 3 |
Vitamin D | Prevention | 10 | 0 | 7 | 0 | 7 |
Classification | Detection | 11 | 4 | 0 | 0 | ‡10 |
Obesity/Weight Management | Prevention | 12 | 0 | 0 | 5 | 1 |
Dietary strategies | Progression | 12 | 11 | 0 | 13 | 3 |
Inflammation | Progression | 12 | 2 | 21 | 0 | 5 |
Collaboration strategies | Progression | 12 | 0 | 0 | 2 | 1 |
Metabolic acidosis | Progression | 12 | 0 | 4 | 0 | 0 |