Department of Paediatric Nephrology, Emma Children's Hospital AMC, Amsterdam, The Netherlands.
Nephrol Dial Transplant. 2013 Dec;28(12):3052-61. doi: 10.1093/ndt/gft303. Epub 2013 Oct 3.
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.
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.
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.
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.
临床实践指南旨在提高医疗质量，但对于指南使用者来说，通常不清楚这些指南是如何制定的，以及建议是否可靠。我们旨在确定所有目前关于慢性透析儿童管理的已发布指南，评估其制定质量，并评估其建议之间的一致性。
我们在 Medline（1948 年至 2012 年 1 月）和指南制定计划的相关网站上进行了搜索。三名审查员使用评估研究和评估指南（AGREE II）工具评估了所有 17 项确定的指南。
这些指南是由五个不同的专业协会制定的。七个肾脏病结局质量倡议（KDOQI）指南中的整体平均 AGREE II 评分被认为是足够的（平均分数为 64-75%），而所有其他 10 个指南的评分较差（29-44%）。七个 KDOQI 指南中有五个在适用性方面得分较弱。我们发现关于开始肾脏替代治疗、血红蛋白水平管理以及使用莫匹罗星预防出口部位感染的建议之间存在重要不一致。
虽然最近制定的 KDOQI 指南符合现代质量标准，但缺乏实施这些建议的建议。迫切需要国际合作和协调，以确保有关慢性透析儿童管理的建议基于相关和高质量的证据。
