Zahran Somaya, Mathew Anna, Harrison Tyrone G, Jauhal Arenn, Hladunewich Michelle A, Mustafa Reem A
Division of Nephrology, Department of Medicine, McGill University, Montreal, Quebec, Canada.
Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Can J Kidney Health Dis. 2025 Jun 30;12:20543581251346074. doi: 10.1177/20543581251346074. eCollection 2025.
In this article, we provide an update on the Canadian Society of Nephrology's (CSN) process of identifying candidate topics and subsequent development of guidelines and commentaries using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT methodology. We revise the process of adapting existing guidelines with the inclusion of Kidney Disease Improving Global Outcomes (KDIGO) practice points. We also describe challenges of implementing guidelines and suggest solutions to address this with description of the CSN approach to disseminating and implementing guidelines.
The update reflects internal CSN documentation, stakeholder consultation for topic prioritization, and integration of methodological guidance from GRADE-ADOLOPMENT and international sources such as KDIGO.
We reviewed and synthesized the CSN's current guideline-development process, which includes a detailed examination of internal documentation, meeting summaries, and publicly available methodological frameworks with specific focus on the application of the GRADE-ADOLOPMENT approach. We analyzed how recommendations and practice points from KDIGO are assessed for relevance, updated based on Canadian context, and integrated into the final commentary using GRADE Evidence-to-Decision (EtD) frameworks. We also examined how conflict of interest is managed, how working groups are structured, and how recommendations are prioritized. In addition, we explored the CSN's evolving strategies for dissemination and implementation, including stakeholder engagement, survey feedback, and use of knowledge-translation tools.
The CSN follows a transparent and rigorous process in guideline and commentary development. This comprehensive process considers the best-available evidence, balancing desirable and undesirable effects and patients' values, perspectives, and implications for the Canadian health care system including resources, equity, acceptability, and feasibility to maximize guideline implementation and advance the health of Canadians.
The CSN updated methods reflect the current process and may not be generalizable to other guideline organizations. The impact of CSN commentaries on clinical practice, decision-making, and policy uptake has not been formally evaluated, limiting our understanding of their contribution to health system improvement and patient outcomes.
This review updates the CSN's processes for commentary working groups to identify relevant international guidelines, establish the level of agreement on included recommendations, incorporate perspectives of people with lived experience, and adjust the final product to the Canadian healthcare system before dissemination.
在本文中，我们介绍了加拿大肾脏病学会（CSN）确定候选主题的过程，以及随后使用推荐分级、评估、制定和评价（GRADE）-ADOLOPMENT方法制定指南和评论的最新情况。我们修订了纳入改善全球肾脏病预后（KDIGO）实践要点来改编现有指南的过程。我们还描述了实施指南的挑战，并提出了解决方案，同时介绍了CSN传播和实施指南的方法。
本更新反映了CSN的内部文件、就主题优先级进行的利益相关者咨询，以及GRADE-ADOLOPMENT和KDIGO等国际来源的方法学指导的整合。
我们回顾并综合了CSN当前的指南制定过程，包括对内部文件、会议总结和公开可用的方法学框架进行详细审查，特别关注GRADE-ADOLOPMENT方法的应用。我们分析了如何评估KDIGO的推荐和实践要点的相关性，如何根据加拿大的情况进行更新，并使用GRADE证据到决策（EtD）框架将其纳入最终评论。我们还研究了如何管理利益冲突、工作组的结构如何以及推荐的优先级如何确定。此外，我们探讨了CSN不断演变的传播和实施策略，包括利益相关者参与、调查反馈以及知识转化工具的使用。
CSN在指南和评论的制定过程中遵循透明且严格的流程。这一全面的过程考虑了现有最佳证据，平衡了有利和不利影响以及患者的价值观、观点，以及对加拿大医疗保健系统的影响，包括资源、公平性、可接受性和可行性，以最大限度地实施指南并促进加拿大人的健康。
CSN更新的方法反映了当前的过程，可能不适用于其他指南制定组织。CSN评论对临床实践、决策和政策采纳的影响尚未得到正式评估，这限制了我们对其对卫生系统改善和患者结局贡献的理解。
本综述更新了CSN评论工作组的流程，以识别相关的国际指南，确定纳入推荐的共识水平，纳入有实际经验者的观点，并在传播前根据加拿大医疗保健系统调整最终产品。
