More detail is needed for updating clinical guidelines
Authors: L. Martínez García, H. Pardo-Hernandez, P. Alonso-Coello
Journal: Kidney International (2016)

We read with great interest the article “Recommendations for Kidney Disease Guideline Updating: A Report by the KDIGO Methods Committee” by Uhlig et al.1Uhlig K. Berns J.S. Carville S. et al.Recommendations for kidney disease guideline updating: a report by the KDIGO Methods Committee.Kidney Int. 2016; 89: 753-760Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar The authors conducted a narrative review on the updating process of clinical guidelines (CG) and presented recommendations to keep KDIGO CGs, and potentially other CGs, up to date. We would like to highlight the following strengths of their work: (i) remarking on the importance of updating for those developing CGs; (ii) linking rigorous and transparent development with a more efficient updating process; (iii) acknowledging the complexity of updating, a field that is under development; (iv) reflecting that a one-size-fits-all updating timeframe is not adequate and is topic dependent; and (v) calling for cooperation among CG developers. Nevertheless, we have some concerns, as the authors: (i) conducted a narrative review that did not identify some relevant publications (e.g., studies on pragmatic search strategies)2Martínez García L. Arévalo-Rodríguez I. Solà I. et al.Strategies for monitoring and updating clinical practice guidelines: a systematic review.Implement Sci. 2012; 7: 109Crossref PubMed Scopus (39) Google Scholar, 3Martínez García L. Sanabria A.J. García Álvarez E. et al.The validity of recommendations from clinical guidelines: a survival analysis.CMAJ. 2014; 186: 1211-1219Crossref PubMed Scopus (88) Google Scholar, 4Martínez García L. Sanabria A.J. Araya I. et al.Efficiency of pragmatic search strategies to update clinical guidelines recommendations.BMC Med Res Methodol. 2015; 15: 57Crossref PubMed Scopus (17) Google Scholar; (ii) provided scant detail on several concepts (e.g., “flexible approaches” when they are referring to a surveillance strategy, or “standards” when they are talking about handbooks), (iii) proposed recommendations that are rather unspecific, instead of more operational strategies (Figure 1); and (iv) commended new technologies that have not been formally evaluated. Finally, we would like to share that the G-I-N Updating Guidelines Working Group provides a network for exchanging knowledge and experiences on methodological and operational issues regarding CG updating (http://www.g-i-n.net/working-groups/updating-guidelines). We hope that KDIGO and other organizations join this initiative to help move forward the updating field. Recommendations for kidney disease guideline updating: a report by the KDIGO Methods CommitteeKidney InternationalVol. 89Issue 4PreviewUpdating rather than de novo guideline development now accounts for the majority of guideline activities for many guideline development organizations, including Kidney Disease: Improving Global Outcomes (KDIGO), an international kidney disease guideline development entity that has produced guidelines on kidney diseases since 2008. Increasingly, guideline developers are moving away from updating at fixed intervals in favor of more flexible approaches that use periodic expert assessment of guideline currency (with or without an updated systematic review) to determine the need for updating. Full-Text PDF Open ArchiveThe Authors ReplyKidney InternationalVol. 90Issue 3PreviewWe appreciate that Martínez García and colleagues have recognized the strengths of our work, which highlights the complexity of keeping guidelines up to date.1,2 Our intent was to provide KDIGO with a framework for rigorously updating its guidelines, not to exhaustively summarize all available literature. We thank Martínez García et al. for their suggestions and agree that the next steps for KDIGO will be to operationalize the recommendations in our article in a manner that fits the size and scope of its guideline program. Full-Text PDF Open Archive