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Department
of Veterans Affairs |
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Title: Management of Chronic Kidney Disease and Pre-ESRD in the Primary Care Setting
| Citation: |
Management of Chronic Kidney Disease and Pre-ESRD in the Primary Care Setting. Washington, DC: VA/DoD Evidence-Based Clinical Practice Guideline Working Group, Veterans Health Administration, Department of Veterans Affairs , and Health Affairs, Department of Defense, November 2000. Office of Quality and Performance publication 10Q-CPG/ESRD-00
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| Completion
Date: Release Date |
August 2000 November 2000 |
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Source(s): |
Washington (DC): The Renal Disease and Pre-ESRD Guideline was developed by and for clinicians from the Department of Veterans Affairs (VA) and the Department of Defense (DoD); 2000.
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Adaptation: |
The guideline draws, in part, from The NKF-DOQI clinical practice guidelines (the National Kidney Foundation-Dialysis Outcomes Quality Initiative, 1997).
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Guideline Status: |
This is a current release of the guideline. An update is targeted for late 2003.
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Developer(s): |
Veterans Health Administration (VHA), Department of Veterans Affairs (VA) - Federal Government Agency [U.S.] Department of Defense (DoD) – Federal Government Agency [U.S.]
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Funding Source: |
U.S. Government
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Committee: |
The Management of Renal Failure Working Group
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Group Composition: |
The list of contributors to the guideline.
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Disease/Condition: |
Chronic Renal Disease and Pre-ESRD
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Category: |
Screening, Diagnosis, Treatment, and Management
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Intended Users: |
Clinical staff including physicians, nurses, nurse practitioners, and physician assistants.
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Target Population: |
Any person with persistent elevated creatinine or proteinuria who is eligible for care in the VA or DoD health care delivery system.
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Contact Person(s): |
VHA |
DOD |
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Thakor G. Patel, MD tgpatel@mail.va.gov |
Paul Welch, LTC, MC, USA Walter Reed Medical Center 6900 Georgia Avenue Washington, DC
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GOALS/OBJECTIVES
· Describe the critical decision points in the management of chronic renal disease.
· Provide a clear and comprehensive guideline incorporating current information and practices for practitioners throughout the DoD and Veterans Health Administration system.
· Improve local management of patients with chronic renal disease and patient outcomes.
INTERVENTIONS AND PRACTICES
The Guideline consists of one algorithm that addresses
distinct aspects of:
· Assessment and Triage
· Pharmacotherapy
· Diet and Patient Education
· Follow-up
OUTCOMES CONSIDERED
Rate of progression of renal disease.
MAJOR RECOMMENDATIONS
The guideline is formatted as a single algorithm,
with annotations. Presentation of the algorithms is intended to assist the
clinician in reviewing and identifying key points that are comprehensively
discussed in the guideline document.
CLINICAL ALGORITHM(S) ARE PROVIDED FOR:
Management
of Chronic Kidney Disease and Pre-ESRD in Primary Care
For an interactive algorithm with links to the annotations
return to the home page and select the link to the Complete Guideline
TYPE OF EVIDENCE
The guideline is supported by the literature in a majority
of areas, with evidence-based tables and references throughout the document.
The evidence consists of key clinical randomized controlled trials
and longitudinal studies in the area of chronic renal disease. Where existing literature is ambiguous or conflicting,
or where scientific data are lacking on an issue, recommendations are based
on the expert panel’s opinion and clinical experience. The guideline contains a bibliography and discussion
of the evidence supporting each recommendation.
DESCRIPTION OF METHODS TO COLLECT EVIDENCE
The algorithm and annotations were based on an exhaustive review
of the literature. The goal of the
literature review was to provide a systematic basis for the development of
an evidence-based guideline. The inclusion
criteria for the literature search were related to the population being studied
(adult) and the treatment setting (primary care).
The
Medical Subject Headings (MeSH) terms used for the search included key therapies
in chronic kidney disease and ESRD, study characteristics, and study design. In this search, “study characteristics” were
those of analytic studies, case-control studies, retrospective studies, cohort
studies, longitudinal studies, follow-up studies, prospective studies, cross-sectional
studies, clinical protocols, controlled clinical trials, RCTs, intervention
studies, and sampling studies. Study
design included crossover studies, double-blind studies, matched pair analysis,
meta-analysis, random allocation, reproducibility of results, and sample size.
METHODS TO ASSESS THE QUALITY AND STRENGTH OF THE
EVIDENCE
The literature search was followed by critical analysis of
the literature, primarily by the clinical experts. To promote the evidence-based
approach, the quality of evidence was rated using a hierarchical rating scheme.
The value of a hierarchical rating scheme is that it provides a systematic
means for evaluating the scientific basis for health care services . The rating scheme used for this guideline is
based on a system used by U.S. Preventive
Services Task Force (U.S. PSTF, 1996).. Decision points in the algorithm are annotated,
and the primary source documents for the annotation are graded.
REVIEW METHODS
Peer Review
ENDORSER(S)
VHA’s National Clinical Practice
Guideline Council
DoD/VA Clinical Practice Guideline Working
Group
QUALIFYING STATEMENTS
Clinical practice guidelines, which are increasingly being
used in health care, are seen by many as a potential solution to inefficiency
and inappropriate variations in care. Guidelines should be evidenced-based
as well as based upon explicit criteria to ensure consensus regarding their
internal validity. However, it must be remembered that the use of guidelines
must always be in the context of a health care provider's clinical judgment
in the care of a particular patient. For that reason, the guidelines may be
viewed as an educational tool analogous to textbooks and journals, but in
a more user-friendly format.
GUIDELINE
AVAILABILITY
Electronic copies
available from: Office of Quality and Performance Web Site.
Print
copies available from: The Office of Quality and Performance (10Q)
Veterans Health Administration, Department of Veterans Affairs.
810 Vermont, NW
Washington, DC 20420
Copy Statement: No copyright restrictions apply