[Clinical practice guidelines for the management of chronic kidney disease stages 3b, 4 and 5 in the Peruvian Health Social Security]
DOI:
https://doi.org/10.35434/rcmhnaaa.2023.161.1709Keywords:
Chronic kidney disease, Clinical practice guidelines, GRADE, Evidence-based medicineAbstract
Introduction: This article summarizes the clinical practice guideline (CPG) for the management of stage 3b, 4, and 5 chronic kidney disease (CKD) in the Social Security of Peru (EsSalud). Objective: To provide evidence-based clinical recommendations for the management of stage 3b, 4, and 5 CKD in EsSalud. Methods: A guideline development group (GDG) was formed, including specialists and methodologists. The GDG formulated 9 clinical questions. Systematic searches for systematic reviews and primary studies were conducted in PubMed from December 2020 to August 2021. Evidence was selected to answer the clinical questions posed. The certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The GDG used the GRADE methodology to review the evidence and formulate recommendations, points of good clinical practice (GPC), and management flowcharts. Finally, the CPG was approved with Resolution No. 88-IETSI-ESSALUD-2021. Results: This CPG addressed 9 clinical questions. Based on these questions, 17 recommendations (7 strong and 10 conditional), 28 GPC points, and 4 management flowcharts were formulated. Conclusion: This article summarizes the methodology and evidence-based conclusions of the CPG for the management of stage 3b, 4, and 5 CKD in EsSalud.
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Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl 2013; 3:1.
United States Renal Data System. USRDS 2013 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institutes of Health; National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 2013.
Bravo-Zúñiga J, Gálvez-Inga J, Carrillo-Onofre P, Chávez-Gómez R, Castro-Monteverde P. Early detection of chronic renal disease: coordinated work between primary and specialized care in an ambulatory renal network of Peru. Braz. J. Nephrol. 2019;41(2):176-84. doi: 10.1590/2175-8239-JBN-2018-0101
Bravo-Zúñiga J, Hinostoza-Sayas J, Goicochea-Lugo S, Dolores-Maldonado G, Brañez-Condorena A, Taype-Rondan A, et al. Guía de práctica clínica para el tamizaje, diagnóstico y manejo de la enfermedad renal crónica en estadios 1 al 3 en el Seguro Social del Perú (EsSalud). Acta Méd Peru. 2020; 37(4):518-531. doi:10.35663/amp.2020.374.1843.
Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. Journal of clinical epidemiology. 2011;64(4):401-6.
Shi Y, Xiong J, Chen Y, Deng J, Peng H, Zhao J, He J. The effectiveness of multidisciplinary care models for patients with chronic kidney disease: a systematic review and meta-analysis. Int Urol Nephrol. 2018;50(2):301-312. doi: 10.1007/s11255-017-1679-7.
Lopez-Vargas PA, Tong A, Howell M, Craig JC. Educational Interventions for Patients With CKD: A Systematic Review. Am J Kidney Dis. 2016;68(3):353-70. doi: 10.1053/j.ajkd.2016.01.022.
Li Q, Wen F, Wang Y, Li S, Lin S, Qi C, et al. Diabetic Kidney Disease Benefits from Intensive Low-Protein Diet: Updated Systematic Review and Meta-analysis. Diabetes therapy: research, treatment and education of diabetes and related disorders. 2021;12(1):21-36.
Navaneethan S, Shao J, Buysse J, Bushinsky DA. Effects of Treatment of Metabolic Acidosis in CKD: A Systematic Review and Meta-Analysis. Clin J Am Soc Nephrol. 2019;14(7):1011-1020. doi: 10.2215/CJN.13091118.
Taylor K, Mclellan J, Verbakel J, Aronson J, Lasserson D, Et al. Effects of antihypertensives, lipid-modifying drugs, glycaemic control drugs and sodium bicarbonate on the progression of stages 3 and 4 chronic kidney disease in adults: a systematic review and meta-analysis. BMJ Open. 2019; 9(9):e030596. doi: 10.1136/bmjopen-2019-030596.
Malhotra R, Nguyen HA, Benavente O, Mete M, Howard BV, et al. Association Between More Intensive vs Less Intensive Blood Pressure Lowering and Risk of Mortality in Chronic Kidney Disease Stages 3 to 5: A Systematic Review and Meta-analysis. JAMA Intern Med. 2017;177(10):1498-1505. doi: 10.1001/jamainternmed.2017.4377.
Tsai W, Wu H, Peng Y, Yang J, Chen H, Chiu Y, Hsu S, Ko M, Pai M, Tu Y, Hung K, Chien K. Association of Intensive Blood Pressure Control and Kidney Disease Progression in Nondiabetic Patients With Chronic Kidney Disease: A Systematic Review and Meta-analysis. JAMA Intern Med. 2017;177(6):792-799. doi: 10.1001/jamainternmed.2017.0197.
Sampson AL, Singer RF, Walters GD. Uric acid lowering therapies for preventing or delaying the progression of chronic kidney disease. Cochrane Database of Systematic Reviews 2017, Issue 10. Art. No.: CD009460. doi: 10.1002/14651858.CD009460.pub2.
Liu X, Zhai T, Ma R, Luo C, Wang H, Liu L. Effects of uric acid-lowering therapy on the progression of chronic kidney disease: a systematic review and meta-analysis. Ren Fail. 2018;40(1):289-297. doi: 10.1080/0886022X.2018.1456463.
IETSI. Guía de Práctica Clínica para el manejo de los trastornos minerales y óseos en enfermedad renal crónica. Guía en Versión Corta. GPC N° 8. Perú, diciembre 2017. Link: http://www.essalud.gob.pe/ietsi/pdfs/guias/GPC-Trastornos-Minerales-y-Oseos-en-ERC-Version-Corta.pdf
IETSI. Guía de práctica clínica para el diagnóstico y manejo de la anemia en pacientes con enfermedad renal crónica. Guía en Versión Extensa. GPC N° 10 Perú, diciembre 2017. Link: http://www.essalud.gob.pe/ietsi/pdfs/guias/GPC-Anemia-en-ERC-Version-Extensa.pdf
Wongrakpanich S, Susantitaphong P, Isaranuwatchai S, Chenbhanich J, Eiam-Ong S, Jaber BL. Dialysis Therapy and Conservative Management of Advanced Chronic Kidney Disease in the Elderly: A Systematic Review. Nephron. 2017;137(3):178-189. doi: 10.1159/000477361.
Verberne WR, van den Wittenboer ID, Voorend CGN, Abrahams AC, van Buren M, Dekker FW, van Jaarsveld BC, van Loon IN, Mooijaart SP, Ocak G, van Delden JJM, Bos WJW. Health-related quality of life and symptoms of conservative care versus dialysis in patients with end-stage kidney disease: a systematic review. Nephrol Dial Transplant. 2021;36(8):1418-1433. doi: 10.1093/ndt/gfaa078.
Phongtankuel V, Meador L, Adelman RD, Roberts J, Henderson CR Jr, Mehta SS, Del Carmen T, Reid MC. Multicomponent Palliative Care Interventions in Advanced Chronic Diseases: A Systematic Review. Am J Hosp Palliat Care. 2018;35(1):173-183. doi: 10.1177/1049909116674669.
Schroth R, Hitchon C, Uhanova J, Noreddin A, Taback S, Moffatt M, et al. Hepatitis B vaccination for patients with chronic renal failure. Cochrane Database Syst Rev. 2004(3):Cd003775.
Remschmidt C, Wichmann O, Harder T. Influenza vaccination in patients with end-stage renal disease: systematic review and assessment of quality of evidence related to vaccine efficacy, effectiveness, and safety. BMC Med. 2014;12:244.
Chuasuwan A, Pooripussarakul S, Thakkinstian A, Ingsathit A, Pattanaprateep O. Comparisons of quality of life between patients underwent peritoneal dialysis and hemodialysis: a systematic review and meta-analysis. Health Qual Life Outcomes. 2020;18(1):191. https://doi.org/10.1186/s12955-020-01449-2.
Ali H, Soliman K, Mohamed MM, Daoud A, Shafiq T, Fülöp T, Baharani J. The effects of dialysis modality choice on cognitive functions in patients with end-stage renal failure: a systematic review and meta-analysis. Int Urol Nephrol. 2021;53(1):155-163. doi: 10.1007/s11255-020-02603-x.
Zhan X, Yang M, Chen Y, Zhang L, Yan C, Wang Y. Comparison of risk of stroke in patients treated with peritoneal dialysis and hemodialysis: a systematic review and meta-analysis. Ren Fail. 2019;41(1):650-656. doi: 10.1080/0886022X.2019.1632210.
Lozier MR, Sanchez AM, Lee JJ, Tamariz LJ, Valle GA. Comparison of Cardiovascular Outcomes by Dialysis Modality: A Systematic Review and Meta-Analysis. Perit Dial Int. 2019;39(4):306-314. doi: 10.3747/pdi.2018.00227.
Foote C, Kotwal S, Gallagher M, Cass A, Brown M, Jardine M. Survival outcomes of supportive care versus dialysis therapies for elderly patients with end-stage kidney disease: A systematic review and meta-analysis. Nephrology (Carlton). 2016;21(3):241-53. doi: 10.1111/nep.12586.
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Copyright (c) 2023 Jessica Bravo-Zúñiga , David Garcia-Gomero , Gandy Golores-Maldonado , Juana Hinostroza-Sayas , Jorge Chávez-Gómez , Carola Medina-Sal y Rosas , Víctor Meneses-Liendo , Carlos Pereda-Vejarano , Fernando Gonzales-Haro , Luis Pérez-Arteaga , César Loza-Munarris, Boris Medina-Santander, Rosana Chaud-Covarrubias, Jorge Hancco-Saavedra, Alvaro Taype-Rondan, Stefany Salvador-Salvador , Lourdes Carrera Acosta
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