Weckmann Gesine F C, Stracke Sylvia, Haase Annekathrin, Spallek Jacob, Ludwig Fabian, Angelow Aniela, Emmelkamp Jetske M, Mahner Maria, Chenot Jean-François
Department of General Practice, Institute for Community Medicine, University Medicine Greifswald, Fleischmannstr. 6, 17475, Greifswald, Germany.
Faculty of Applied Health Sciences, European University of Applied Sciences, Rostock, Germany.
BMC Nephrol. 2018 Oct 11;19(1):258. doi: 10.1186/s12882-018-1048-5.
Chronic kidney disease (CKD) is age-dependent and has a high prevalence in the general population. Most patients are managed in ambulatory care. This systematic review provides an updated overview of quality and content of international clinical practice guidelines for diagnosis and management of non-dialysis CKD relevant to patients in ambulatory care.
We identified guidelines published from 2012-to March 2018 in guideline portals, databases and by manual search. Methodological quality was assessed with the Appraisal of Guidelines for Research and Evaluation II instrument. Recommendations were extracted and evaluated.
Eight hundred fifty-two publications were identified, 9 of which were eligible guidelines. Methodological quality ranged from 34 to 77%, with domains "scope and purpose" and "clarity of presentation" attaining highest and "applicability" lowest scores. Guidelines were similar in recommendations on CKD definition, screening of patients with diabetes and hypertension, blood pressure targets and referral of patients with progressive or stage G4 CKD. Definition of high risk groups and recommended tests in newly diagnosed CKD varied.
Guidelines quality ranged from moderate to high. Guidelines generally agreed on management of patients with high risk or advanced CKD, but varied in regarding the range of recommended measurements, the need for referrals to nephrology, monitoring intervals and comprehensiveness. More research is needed on efficient management of patients with low risk of CKD progression to end stage renal disease.
慢性肾脏病（CKD）与年龄相关，在普通人群中患病率很高。大多数患者在门诊接受治疗。本系统评价提供了与门诊患者相关的非透析CKD诊断和管理的国际临床实践指南的质量和内容的最新概述。
我们在指南门户网站、数据库中通过手动检索确定了2012年至2018年3月发表的指南。使用《研究与评价指南II》工具评估方法学质量。提取并评估推荐意见。
共识别出852篇出版物，其中9篇为符合条件的指南。方法学质量在34%至77%之间，“范围和目的”以及“表述清晰度”领域得分最高，“适用性”得分最低。指南在CKD定义、糖尿病和高血压患者筛查、血压目标以及进展性或G4期CKD患者转诊的推荐意见上相似。新诊断CKD中高危组的定义和推荐检查各不相同。
指南质量从中等至高不等。指南在高危或晚期CKD患者的管理上总体一致，但在推荐测量范围、转诊至肾脏病科的必要性、监测间隔和全面性方面存在差异。对于CKD进展至终末期肾病低风险患者的有效管理，还需要更多研究。
