Guideline Development Process

KDOQI strives to make clinical practice guideline development as transparent and efficient as possible. It generally takes 18-24 months from development of a scope of work to submission of the manuscript to AJKD.

Our process is as follows: 

  • National Kidney Foundation Scientific Advisory Board approves the topic for guideline development or update.
  • KDOQI Chairs select a Work Group Chair/Co-Chair based on previous work in the area, a clear understanding of the guideline development process, and willingness and ability to commit time to the project.
  • Scope of Work document is developed by the Work Group Chair/Co-Chair
  • Work group chair/co-chairs invite work group members with the aim of creating a diverse, multidisciplinary group. Work group may include representation from nephrology, vascular surgery, pediatric nephrology, pharmacy, nutrition, social work, nursing, general practice, transplantation and/or other pertinent medical subspecialties. (KDOQI is currently working on a strategy for formal patient input throughout the guideline development process. This is a priority for us, and we hope to publish plans in late 2016).
  • Individuals being considered for work group membership declare any potentially conflicting interests and activities by written disclosure. Disclosures include all current and planned commercial, non-commercial, intellectual, institutional, and patient/public activities relating to the scope of the guideline.
  • KDOQI contracts with an evidence review team (ERT), generally an AHRQ Evidence based Practice Center, to carry out a formal systematic review.
  • Scope of Work is refined by the ERT and wider workgroup. (Beginning in 2017, KDOQI aims to publish Guideline Scope documents for public review)
  • The ERT and work group collaborate throughout the literature review process, including:
    • Formulating the research questions and developing an analytic framework
    • Pre-specifying the approach and methods
    • Assessing abstracts for inclusion/exclusion
  • The ERT produces an evidence report with findings from the literature review. This is submitted to AJKD for publication.
  • The work group uses these findings to make clinical practice guidelines (high quality evidence) and clinical practice recommendations (lower quality evidence, consensus based recommendations), and grades them using the GRADE methodology. Each guideline and recommendation is published along with a rationale, including a summary of relevant available evidence (and gaps in evidence), and an explanation of potential benefits and harms.
  • The work group also provides recommendations for further research and limitations of current data within each chapter. View research recommendations from all past KDOQI guidelines (download PDF)
     

KDOQI Guideline Peer Review Process

Internal Review

  • Once the guideline text is signed off by the Work Group Chairs, recommendations are formatted and circulated to KDOQI Leadership and the National Kidney Foundation Scientific Advisory Board for review. Reviewers are asked to use an online form that presents each recommendation along with a box to check “agree” or “disagree” and space for comment.
  • At the discretion of the KDOQI Chair, select outside experts may be invited to comment at this stage.
  • If the guideline is jointly produced with another organization, that organization will carry out an internal review simultaneously. 
  • Reviewer comments are collated by KDOQI staff and sent to the Work Group for discussion and possible edits. 
  • Following edits, the guideline document is made available for public review.

External (Public) Review

  • Throughout the latter stages of guideline development, a link to register for public review is posted to the NKF guidelines web page.
  • The document is sent to registered reviewers and publicized to other individuals and groups with an interest in the topic.
  • Public reviewers are provided with a link to the online form that presents each recommendation along with a box to check “agree” or “disagree” and space for comment.
  • Reviewer comments are collated by KDOQI staff and sent to the Work Group for discussion and possible edits. 
  • Individual Work Group members are asked to address comments pertaining to recommendations and sections they have authored.
  • The Work Group Chairs coordinate the final rewriting of the guideline document based on the public review comments.

The updated guideline is submitted for publication in the American Journal of Kidney Diseases (AJKD)

KDOQI Guideline Development Timeline 

KDOQI continually updates a selection of its original clinical practice guidelines. Updates are initiated when enough new evidence becomes available of high enough quality to change current recommendations, e.g. a recommended intervention causes previously unknown substantial harm, a new intervention is significantly superior to a previously recommended intervention, or a recommendation can be applied to a new population.

We are aiming for the following review/publication schedule, where applicable:

Topic

Expected publication

Vascular Access (in-process)

Late 2017/2018

Nutrition in CKD (in-process)

Late 2017/2018

Peritoneal Dialysis Adequacy
(previous update 2006) 

2019

Cardiovascular Disease in Dialysis Patients (previous update 2005)

2019

Diabetes and Chronic Kidney Disease
(previous update 2012)

2021

Hemodialysis Adequacy
(previous update 2015)

2021