Department of Nephropathy and Endocrine, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100010, China.
Centre for Evidence-Based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100010, China.
J Tradit Chin Med. 2024 Jun;44(3):609-619. doi: 10.19852/j.cnki.jtcm.20240402.002.
To assess the quality of Clinical practice guidelines (CPGs) in the context of diabetic kidney disease (DKD) and determine whether any factors affect the quality.
We searched eight databases along with five international and national organizations to develop or archive guidelines from their inception to July 2023, with an additional search of medlive.cn. And the authoritative organizations related to nephrology. CPGs and consensus statements created using direct differential diagnosis or therapy for DKD were included without language restrictions. Their quality was evaluated by four reviewers using the Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ) instrument. Along with the item and domain scores, the guideline was also allocated an overall quality score, which ranged from 1 (lowest possible quality) to 7 (highest possible quality). Moreover, an overall recommendation for use was also assigned ("recommended", "recommended with modifications" or "not recommended").
A total of 16 CPGs were included, of which 14 were from Asia and the remaining two from Europe. These two CPGs were updated in the third version. Six CPGs were recommended for use because their primary domains scored in the medium or high category. Furthermore, five CPGs were recommended with modifications as the stakeholder involvement, applicability, and editorial independence domains were evaluated as low categories. In all domains, the lowest average score was for rigour of development (33%), followed by application (36%), and stakeholder involvement (51%). The highest average score was for scope and purpose (79%), followed by clarity of presentation (75%). None of the CPGs considered the patient's viewpoint, and six of 16 CPGs did not use any grading system to translate the evidence into recommendations. Additionally, only three of 16 CPGs shared search strategy, and eight of 16 CPGs did not declare a funding source.
According to the AGREE II evaluation, more than one in four CPGs for DKD had poor methodological quality. Enhanced efforts are needed to advance the rigour of development, application, and editorial independence of DKD guideline panels for most guidelines. Stakeholders, CPG developers, and CPG users should consider methodological quality while choosing CPGs, and interpret and implement their issued suggestions.
评估糖尿病肾病（DKD）背景下临床实践指南（CPG）的质量，并确定是否有任何因素影响质量。
我们从八个数据库以及五个国际和国家组织中进行了搜索，以开发或从其成立开始存档指南，直到 2023 年 7 月，并在 medlive.cn 上进行了额外搜索。以及与肾脏病学相关的权威组织。纳入了使用直接鉴别诊断或 DKD 治疗的 CPG 和共识声明，无语言限制。使用评估研究和评估指南 Ⅱ（AGREE Ⅱ）工具由四位评审员评估其质量。除了项目和领域评分外，还为指南分配了整体质量评分，范围从 1（最低可能质量）到 7（最高可能质量）。此外，还分配了总体推荐使用建议（“推荐”、“推荐修改”或“不推荐”）。
共纳入 16 项 CPG，其中 14 项来自亚洲，其余 2 项来自欧洲。这两个 CPG 在第三版中进行了更新。由于主要领域评分处于中高类别，因此有 6 项 CPG 被推荐使用。此外，由于利益相关者参与、适用性和编辑独立性领域被评估为低类别，因此有 5 项 CPG 被推荐修改。在所有领域中，发展严谨性的平均最低得分为 33%，其次是应用（36%）和利益相关者参与（51%）。最高平均得分是范围和目的（79%），其次是演示文稿的清晰度（75%）。没有 CPG 考虑患者的观点，16 项 CPG 中有 6 项没有使用任何分级系统将证据转化为建议。此外，只有 16 项 CPG 中的 3 项共享搜索策略，16 项 CPG 中的 8 项没有声明资金来源。
根据 AGREE II 评估，超过四分之一的 DKD CPG 方法学质量较差。需要加强努力，提高大多数指南的 DKD 指南小组的发展、应用和编辑独立性的严谨性。利益相关者、CPG 开发人员和 CPG 用户在选择 CPG 时应考虑方法学质量，并解释和实施他们发布的建议。
