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Priority topics for European multidisciplinary guidelines on the management of chronic kidney disease in older adults

  • Nephrology - Original Paper
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Abstract

Purpose

To identify and prioritize potential topics to be addressed in the development of European multidisciplinary guidelines on the management of chronic kidney disease stage 3b–5 in older patients.

Methods

We composed a list of 47 potential guideline topics by reviewing the literature, consulting online 461 nephrologists and 107 geriatricians, and obtaining expert input. A multidisciplinary panel of twelve experts then prioritized the topics during a face-to-face consensus meeting, following a nominal group technique structure with two voting rounds. Topics were rated on a 9-point scale ranging from 1 (‘not at all important’) to 9 (‘critically important’).

Results

The highest rating (median; range) was assigned to ‘Screening and referral’ (8.5; 2.0). Eight topics shared the second highest rating with a median priority score of 8.0 (2.0) and included ‘Starting dialysis or not’ and ‘Accurate assessment of renal function.’ ‘Targets for and treatment of diabetes’ received the lowest rating with (3.0; 6.0).

Conclusions

This joint initiative of the European Renal Association–European Dialysis Transplant Association (ERA–EDTA) and the European Union Geriatric Medicine Society (EUGMS) prioritized the development of guidance on interdisciplinary referral of older patients with chronic kidney disease stage 3b–5. Future guidance will therefore focus on identifying prognostic scores to predict death and progression to end-stage renal disease, as well as accurate tests for assessment of renal function in older kidney patients. This will contribute to more informed treatment decision making in this growing patient population.

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Author information

Authors and Affiliations

  1. European Renal Best Practice Methods Support Team, Ghent University Hospital, Ghent, Belgium

    Sabine N. van der Veer, Wim van Biesen, Davide Bolignano & Ionut Nistor

  2. Renal Division, Ghent University Hospital, Ghent, Belgium

    Wim van Biesen

  3. Nephrology Department, AZ Maria Middelares Hospital, Ghent, Belgium

    Pascale Bernaert

  4. CNR-Institute of Clinical Physiology, Reggio Calabria, Italy

    Davide Bolignano

  5. Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK

    Edwina A. Brown

  6. Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania

    Adrian Covic & Ionut Nistor

  7. Renal Unit, Lister Hospital, Stevenage, Hertfordshire, UK

    Ken Farrington

  8. ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands

    Kitty J. Jager

  9. Division of Nephrology, Department of Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands

    Jeroen Kooman

  10. Faculty of Medicine, University of Salamanca, Salamanca, Spain

    Juan F. Macías-Núñez

  11. Renal Unit, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK

    Andrew Mooney

  12. Department of Internal Medicine, University Center of Geriatric Medicine, University Medical Center Groningen, Groningen, The Netherlands

    Barbara C. van Munster

  13. Department of Geriatric Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic

    Eva Topinkova

  14. Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium

    Gerhard Wirnsberger

  15. Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria

    Nele J. A. Van Den Noortgate

  16. University of Geneva, Geneva, Switzerland

    Jean-Pierre Michel

  17. Health eResearch Centre @ Farr Institute for Health Informatics Research, University of Manchester, Vaughan House, Portsmouth Street, Manchester, M13 9GB, UK

    Sabine N. van der Veer

Authors
  1. Sabine N. van der Veer
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  2. Wim van Biesen
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  3. Pascale Bernaert
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  4. Davide Bolignano
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  5. Edwina A. Brown
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  6. Adrian Covic
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  7. Ken Farrington
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  8. Kitty J. Jager
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  9. Jeroen Kooman
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  10. Juan F. Macías-Núñez
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  11. Andrew Mooney
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  12. Barbara C. van Munster
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  13. Eva Topinkova
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  14. Nele J. A. Van Den Noortgate
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  15. Gerhard Wirnsberger
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  16. Jean-Pierre Michel
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  17. Ionut Nistor
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Corresponding author

Correspondence to Sabine N. van der Veer.

Ethics declarations

Ethical standard

This initiative was financially endorsed by the European Renal Association–European Dialysis and Transplant Association (ERA–EDTA). SvdV and IN are ERA–EDTA-funded research fellows working on renal guideline development as members of the Methods Support Team of European Renal Best Practice (http://european-renal-best-practice.org). All authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all experts participating in the study. The procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments.

Human and animal right statement

This article does not contain any studies with animals performed by any of the authors.

Appendices

Appendix 1: search strategy for scoping review of the literature

Medline via OVID

1. Kidney diseases/

2. Exp renal replacement therapy/

3. Renal insufficiency/

4. Exp renal insufficiency, chronic/

5. Dialysis.tw.

6. (Hemodialysis or haemodialysis).tw.

7. (Hemofiltration or haemofiltration).tw.

8. (Hemodiafiltration or haemodiafiltration).tw.

9. (End-stage renal or end-stage kidney or endstage renal or endstage kidney).tw.

10. (ESRF or ESKF or ESRD or ESKD).tw.

11. (Chronic kidney or chronic renal).tw.

12. (CKF or CKD or CRF or CRD).tw.

13. (CAPD or CCPD or APD).tw.

14. (Predialysis or pre-dialysis).tw.

15. Or/1–14

16. Elderly.tw.

17. Community-dwelling.tw.

18. Geriatric.tw.

19. Mini-mental state.tw.

20. Alzheimer*.tw.

21. Mmse.tw.

22. Caregivers.tw.

23. Falls.tw.

24. Adl.tw.

25. Frailty.tw.

26. Gds.tw.

27. Ageing.tw.

28. Hip fractures.tw.

29. Elders.tw.

30. Frail*.tw.

31. Mci.tw.

32. Demented.tw.

28. Hip fractures.tw.

29. Elders.tw.

30. Frail*.tw.

31. Mci.tw.

32. Demented.tw.

33. Psychogeriatrics.tw.

34. Cognitive impairment.tw.

35. Postmenopausal women.tw.

36. Dementia.tw.

37. Aging.tw.

38. Older.tw.

39. Or/16–38

40. 15 and 39

Cochrane’s central register of controlled trials (CENTRAL)

#1 dialysis:ti,ab,kw

#2 h*emofiltration:ti,ab,kw

#3 h*emodiafiltration:ti,ab,kw

#4 (end-stage renal or end-stage kidney or endstage renal or endstage kidney):ti,ab,kw

#5 (ESRF or ESKF or ESRD or ESKD):ti,ab,kw

#6 (chronic kidney or chronic renal):ti,ab,kw

#7 (CKF or CKD or CRF or CRD):ti,ab,kw

#8 (CAPD or CCPD or APD):ti,ab,kw

#9 (predialysis or pre-dialysis):ti,ab,kw

#10 MeSH descriptor: [Kidney failure, chronic] this term only

#11 MeSH descriptor: [Renal replacement therapy] explode all trees

#12 MeSH descriptor: [Renal insufficiency, chronic] explode all trees

#13 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12

#14 Aged, 80 and over

#15 Frail elderly

#16 #14 or #15

#17 #13 and #16

Appendix 2

See Table 2.

Table 2 Priorities for guideline development from online consultation among clinicians; values represent number (%) of respondents who selected a topic
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van der Veer, S.N., van Biesen, W., Bernaert, P. et al. Priority topics for European multidisciplinary guidelines on the management of chronic kidney disease in older adults. Int Urol Nephrol 48, 859–869 (2016). https://doi.org/10.1007/s11255-016-1257-4

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