INTRODUCTION process, topic discussion, and consensus

This chapter provides a very brief summary of the development.

methods Evidence selection, appraisal, and presentation
used to develop this guideline. Detailed methods We first defined the topics and goals for the
are guideline and
provided in Appendix F. The overall aim of the identified key clinical questions for review. The
project was ERT
to create a clinical practice guideline with performed literature searches, organized abstract
recommendations and article
for AKI using an evidence-based approach. After screening, coordinated methodological and
topics and analytic processes
relevant clinical questions were identified, the of the report, defined and standardized the search
pertinent methodology,
scientific literature on those topics was performed data extraction, and summarized the
systematically evidence. The Work Group members reviewed all
searched and summarized. included
Group member selection and meeting process articles, data extraction forms, summary tables,
The KDIGO Co-Chairs appointed the Co-Chairs and evidence
of the Work profiles for accuracy and completeness. The four
Group, who then assembled the Work Group to be major topic
responsible areas of interest for AKI included: i) definition
for the development of the guideline. TheWork and
Group consisted classification; ii) prevention; iii) pharmacologic
of domain experts, including individuals with treatment;
expertise in and iv) RRT. Populations of interest were those at
nephrology, critical care medicine, internal risk for
medicine, pediatrics, AKI (including those after intravascular contrast-
cardiology, radiology, infectious diseases and media
epidemiology. For exposure, aminoglycosides, and amphotericin)
support in evidence review, expertise in methods, and those
and guideline with or at risk for AKI with a focus on patients
development, the NKF contracted with the with sepsis or
Evidence Review trauma, receiving critical care, or undergoing
Team (ERT) based primarily at the Tufts Center cardiothoracic
for Kidney surgery. We excluded studies on AKI from
Disease Guideline Development and rhabdomyolysis,
Implementation at Tufts specific infections, and poisoning or drug
Medical Center in Boston, Massachusetts, USA. overdose. Overall,
The ERT we screened 18 385 citations.
consisted of physician-methodologists with Outcome selection judgments, values, and
expertise in nephrology preferences
and internal medicine, and research associates and We limited outcomes to those important for
assistants. decision making,
The ERT instructed and advised Work Group including development of AKI, need for or
members in all dependence on
steps of literature review, critical literature RRT, and all-cause mortality. When weighting the
appraisal, and evidence
guideline development. The Work Group and the across different outcomes, we selected as the
ERT ‘‘crucial’’ outcome
collaborated closely throughout the project. The that which weighed most heavily in the
Work Group, assessment of the
KDIGO Co-Chairs, ERT, liaisons, and NKF overall quality of evidence. Values and
support staff met for preferences articulated
four 2-day meetings for training in the guideline by the Work Group included: i) a desire to be
development inclusive in
terms of meeting criteria for AKI; ii) a progressive guideline topics involve diagnosis and staging or
approach to AKI, and
risk and cost such that, as severity increased, the here the Work Group chose to provide ungraded
group put statements.
greater value on possible effectiveness of These statements are indirectly supported by
strategies, but evidence on risk
maintained high value for avoidance of harm; iii) relationships and resulted from unanimous
intent to consensus of the
guide practice but not limit future research. Work Group. Thus, the Work Group feels they
Grading the quality of evidence and the strength of should not be
recommendations viewed as weaker than graded recommendations.
The grading approach followed in this guideline is
adopted SPONSORSHIP
from the GRADE system.40,41 The strength of each KDIGO gratefully acknowledges the following
recommendation sponsors that
is rated as level 1 which means ‘‘strong’’ or level make our initiatives possible: Abbott, Amgen,
2 Belo Foundation,
which means ‘‘weak’’ or discretionary. The Coca-Cola Company, Dole Food Company,
wording corresponding Genzyme,
to a level 1 recommendation is ‘‘We recommend Hoffmann-LaRoche, JC Penney, NATCO—The
y Organization
should’’ and implies that most patients should for Transplant Professionals, NKF—Board of
receive the Directors,
course of action. The wording for a level 2 Novartis, Robert and Jane Cizik Foundation,
recommendation Shire,
is ‘‘We suggestymight’’ which implies that Transwestern Commercial Services, and Wyeth.
different choices KDIGO is
will be appropriate for different patients, with the supported by a consortium of sponsors and no
suggested funding is
course of action being a reasonable choice in accepted for the development of specific
many patients. guidelines.
In addition, each statement is assigned a grade for DISCLAIMER
the quality While every effort is made by the publishers,
of the supporting evidence, A (high), B editorial board,
(moderate), C (low), and ISN to see that no inaccurate or misleading
or D (very low). Table 1 shows the implications of data, opinion
the or statement appears in this Journal, they wish to
guideline grades and describes how the strength of make it clear
the that the data and opinions appearing in the articles
recommendations should be interpreted by and
guideline users. advertisements herein are the responsibility of the
Furthermore, on topics that cannot be subjected to contributor,
systematic evidence review, the Work Group copyright holder, or advertiser concerned.
could issue Accordingly, the
statements that are not graded. Typically, these publishers and the ISN, the editorial board and
provide their respective
guidance that is based on common sense, e.g., employers, office and agents accept no liability
reminders of whatsoever for
the obvious and/or recommendations that are not the consequences of any such inaccurate or
sufficiently misleading data,
specific enough to allow the application of opinion or statement.While every effort is made to
evidence. The ensure that
GRADE system is best suited to evaluate evidence drug doses and other quantities are presented
on accurately,
comparative effectiveness. Some of our most readers are advised that new methods and
important techniques
involving drug usage, and described within this
Journal,
should only be followed in conjunction with the
drug
manufacturer’s own published literature.
SUPPLEMENTARY MATERIAL
Appendix F: Detailed Methods for Guideline
Development.
Supplementary material is linked to the online version of
the paper at
http://www.kdigo.org/clinical_practice_guidelines/AKI.php