Quality and consistency of clinical practice guidelines for the management of children on chronic dialysis

Nephrol Dial Transplant. 2013 Dec;28(12):3052-61. doi: 10.1093/ndt/gft303. Epub 2013 Oct 3.


Background: Clinical practice guidelines aim to improve the quality of care, yet for users of guidelines it is often not clear how these guidelines were developed and whether the recommendations are robust. We aimed to identify all current published guidelines for the management of children on chronic dialysis, assess the quality of their development and evaluate consistency among their recommendations.

Methods: We searched Medline (1948 to January 2012), and relevant websites of guideline development programmes. Three reviewers appraised all 17 identified guidelines with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument.

Results: The guidelines were developed by five different professional associations. The overall mean AGREE II score from seven Kidney Disease Outcomes Quality Initiatives (KDOQI) guidelines was considered sufficient (mean scores 64-75%), and from all other 10 guidelines poor (29-44%). Five out of seven KDOQI guidelines scored weak on applicability. We found important inconsistencies between recommendations concerning initiation of renal replacement therapy, management of haemoglobin level and the use of mupirocin to prevent exit-site infections.

Conclusions: While the recently developed KDOQI guidelines meet the modern quality standards, advice for implementation of these recommendations is lacking. There is an urgent need for international collaboration and coordination to ensure that the management of children on chronic dialysis is informed by relevant and high-quality evidence.

Keywords: dialysis; end-stage kidney disease; guidelines; paediatric nephrology; systematic review.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Evidence-Based Medicine
  • Humans
  • Practice Guidelines as Topic / standards*
  • Program Development
  • Quality Control*
  • Quality of Health Care*
  • Renal Dialysis*