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  • To accomplish its mission, KDIGO is engaged in the following initiatives: - Clinical Practice Guidelines – develop evidence-based guidelines in nephrology - Controversies Conferences - KDIGO’s Controversies Conferences examine significant nephrology topics that result in a published position paper to share with the community. - Implementation Task Force - assist in the dissemination and clinical integration of guidelines - KDIGO Website – guideline resource easily accessible to the global nephrology community
  • KDIGO was founded in 2003 and was incorporated under Belgium law as a non-profit foundation. Rationale for a Global Initiative - There is an increasing prevalence of kidney disease worldwide. - The complications and problems of patients with kidney disease are universal. - There is a need to develop a public health approach to this global epidemic of kidney disease. - Resources may vary, but the science and evidence-based care of complications and problems encountered by those afflicted by CKD are universal and independent of geographical location or national borders. - There is a clear need for strategic initiatives, which will improve the care of patients with kidney disease worldwide. - It is important to increase the efficiency of utilizing available expertise and resources in improving global outcomes of kidney disease and avoid duplication of efforts. - There is room for improving international cooperation in the development, dissemination and implementation of clinical practice guidelines to achieve these goals.
  • - Board of Directors – the organization is led by an international Board of Directors made up of 50 volunteer members representing 6 continents, consisting of primarily nephrologists, but also patient reporesentatives and other medical disciplines -cardiologists, patients, epidemiologists. The Board meets annually. 2 Board Co-chairs liase directly with KDIGO staff on the day to day operations of KDIGO. - Executive Committee – 11 members. Meets in-person at least twice a year with conference calls as needed. The executive committee oversees KDIGO Activites, determines future objectives and activites, and appoints work group leaders. - Nominating committee – Five member committee makes recommendations for new board members, the executive committee and Board Co-chairs. Board postions are 3 year, rotating terms. - Board of Councelors – made up of retired Board members, they advise and comment on KDIGO activities and reviews guideline drafts - Evidence Review Team - the team at the Tufts New England Medical Center provides methodologic support and evidence searches for all KDIGO Guidelines - KDIGO Clinical Practice Guideline Workgroups – Traditionally made up of 15-20 volunteer experts and liason members from relevant societies, led by 2 co-chairs - Implementation Task Force – 6 regional members charged with disseminating and implementing guidelines locally through a team of regional representatives - Liaison Task Force – made up of representatives of each of the primary English speaking global guideline organizations: Caring for Australians with Renal Impairment (CARI), United Kingdom Renal Association (UK-RA), Canadian Society of Nephrology (CSN), Kidney Disease Outcomes Quality Initiative (KDOQI), and European Renal Best Practice (ERBP). Particpate in the review of KDIGO Guidelines and promote communication to harmonize the development of international guidelines. KDIGO is managed by the National Kidney Foundation, headquartered in New York, USA
  • Approximately 50 Board members representing 22 countries and 6 continents.
  • - 11 members Executive Committee - Meets regularly to oversee KDIGO Activities
  • Guiding principles for the KDIGO guideline development process include: • Scientific and methodological rigor––The process will be evidence-based. The grading of the evidence and recommendations will adhere to the position statement of KDIGO on the grading evidence and recommendations for clinical practice guidelines. • Interdisciplinary approach––Work group members will be chosen for leadership in their respective fields, commitment to quality of care and expertise in clinical practice, with due consideration of international representation reflecting the mission statement of KDIGO. • Independence of work groups––The workgroup will have independence and final responsibility in the formulation of recommendations. This will assure an unbiased approach to guideline development, without influence of organizations or industry • Openness of the guideline development process––Following their initial review by KDIGO Executive Committee and Board of Directors, the draft guidelines will be subjected to an organizational and public review process that invites comment from international groups and professionals whom the guidelines will affect. Comments submitted at each phase of the review process will be carefully reviewed and considered by the Work Group prior to publication of the final guidelines.
  • GRADE enables an important distinction to be made between the quality of the evidence and the strength of the recommendation. In the modified GRADE approach used by KDIGO, four different levels are used to characterize the quality of evidence as either high (A), moderate (B), low (C) or very low (D). Two different levels (1 or 2) are used to characterize the strength of a recommendation. A level 1 grading implies that a recommendation should almost always be followed. By contrast, a level 2 recommendation should be applied for the majority of circumstances, but always requires weighing of the risks and benefits for each specific situation, taking into account the patient’s preferences and values. Although under specific circumstances a level 1 recommendation can form the basis for a clinical performance measure by defining an expected standard of care, level 2 recommendations are definitely unsuitable for transformation into a clinical performance measure, given the degree of uncertainty that following the recommendation will improve patient outcomes. Moreover, a level 1 recommendation is considered to be unlikely to change with the results of future research, and as such, the necessity of further trials in that particular area requires very careful consideration. On the other hand, a level 2 recommendation clearly indicates that further research to test alternative methods of patient care may be useful. Although the higher the quality of the evidence the higher the likelihood of a strong recommendation being derived, no direct algorithm exists that links the strength of a recommendation to the quality of evidence. The combination of the four different levels of evidence quality and the two strengths of recommendation already allows for considerable granularity. In addition, work groups can choose to make an ungraded statement, particularly in areas that are not suitable for systematic evidence review or if the work group decides not to perform such a review. This may occur, for example, when the anticipated outcome of an extensive literature search is highly unlikely to yield high quality evidence and, therefore, the result does not justify the efforts. UNGRADED STATEMENTS: provide guidance based on common sense or reminders to the obvious do not specify an alternative -are not based on systematic evidence review or supported by formal grading process
  • KDIGO Guidelines are primarily published in Kidney International; however, some guideline topics may be for a more specific audience and will be published in alternative professional journals.
  • KDIGO sponsors a series of international Controversies Conferences to examine recent studies, discuss clinical application of new findings, and make treatment recommendations. KDIGO conferences bring together international experts who collectively outline current practice recommendations and identify clinical questions that are then used to steer the evidence review process for the development of future clinical practice guidelines.
  • KDIGO works collaboratively with the six primary organizations that develop nephrology guidelines in English
  • Liaison Task Force – - formed as a cooperative effort between nephrology guideline development organizations to act as a link between the guideline groups and KDIGO in order to facilitate coordination of guideline development and methodology. - consists of an appointed representative from each of the five primary English language guideline development groups (CARI, CSN, ERBP, KDOQI, & UK-RA), along with the KDIGO representative, who will act as chair. - represent their organization in the Annual Board review of all KDIGO guidelines - assist with the continued expansion and updating of the Clinical Practice Guideline database on the KDIGO Website Global Guideline Coordination Group - - The Guideline Coordination Group is comprised of the presidents of the five principal organizations that develop nephrology guidelines in English (CARI, CSN, ERBP, KDOQI & UK-RA); the designated representative from each organization who participate in the KDIGO Liaison Task Force; and the KDIGO Co-chairs and other invited guests. The group meets annually in conjunction with ASN Renal Week. The meeting will be structured to allow each of the organizations to share an overview of planned guideline activities and discuss where coordination of these activities could maximize the efficiency and quality of global guideline development in nephrology. ISN/KDIGO Collaboration Group - Members of the ISN and KDIGO Leadership meet 1-2 times per year to evaluate initiatives of common interest and promote collaborative efforts between the organizations
  • KDIGO Guidelines - The website provides access to all published KDIGO Guidelines in both pdf and html format. - An Executive Summary that includes all of the recommendation statements is available in multiple languages. - To promote presentation and dissemination of the guidelines, slide sets on each guideline can be accessed from the website speaker center Reports from Controversy Conferences - Copies of all published position statements from KDIGO Controversies Conferences are accessible on the website. - Additional information about the conferences, such as the plenary session presentations, are also available.
  • The website guideline database provides overviews by organization (Canadian Society, KDOQI, UK Renal Association etc.) and clinical topic (anemia, hypertension, transplant, etc) for most nephrology guidelines, with direct links to each appropriate section of the guideline.
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    1. 1. KDIGO Overview
    2. 2. <ul><li>Mission </li></ul><ul><li>Governance </li></ul><ul><li>Clinical Practice Guidelines </li></ul><ul><li>Controversies Conferences </li></ul><ul><li>Guideline Coordination </li></ul><ul><li>Guideline Implementation </li></ul><ul><li>Website </li></ul>KDIGO
    3. 3. KDIGO Mission
    4. 4. KDIGO <ul><li>An independently incorporated nonprofit foundation, governed by an international board, with the stated mission to: ‘Improve the care and outcomes of kidney disease patients worldwide through promoting coordination, collaboration, and integration of initiatives to develop and implement clinical practice guidelines.’ </li></ul>
    5. 5. KDIGO Governance
    6. 6. Organizational Structure Board Board of Councelors (retired BOD members) Management : National Kidney Foundation <ul><li>KDIGO Workgroups </li></ul><ul><li>CPG Workgroups </li></ul><ul><li>Liaison Task Force </li></ul><ul><li>Implementation Task Force </li></ul>Evidence review : Evidence Review Team Tufts NEMC Executive Committee Nominating committee Foundation under Belgium law
    7. 7. KDIGO Board of Directors <ul><li>Omar I. Abboud, MD, SUDAN </li></ul><ul><li>Sharon Adler, MD, USA </li></ul><ul><li>Sharon P. Andreoli, MD, USA </li></ul><ul><li>Robert Atkins, MD, AUSTRALIA </li></ul><ul><li>Gavin Becker, MD, AUSTRALIA </li></ul><ul><li>Fred Brown, MBA, USA </li></ul><ul><li>Evelyn Butera, RN, USA </li></ul><ul><li>Daniel Cattran, MD, CANADA </li></ul><ul><li>Allan Collins, MD, USA </li></ul><ul><li>Ricardo Correa-Rotter, MD, MEXICO </li></ul><ul><li>Olivier Coustere, Tx Recipient, FRANCE </li></ul><ul><li>Adrian Covic, MD, ROMANIA </li></ul><ul><li>Jonathon Craig, MD, AUSTRALIA </li></ul><ul><li>Angel de Francisco, MD, SPAIN </li></ul><ul><li>Paul de Jong, MD, NETHERLANDS </li></ul><ul><li>Tilman Drüeke, MD, FRANCE </li></ul><ul><li>Garabed Eknoyan, MD, USA </li></ul><ul><li>Denis P. Fouque, MD, FRANCE </li></ul><ul><li>Mohammed Benghanem Gharbi, MD, MORROCO </li></ul><ul><li>Gordon Guyatt, MD, CANADA </li></ul><ul><li>Philip Halloran, MD, CANADA </li></ul>Co-Chairs: Kai-Uwe Eckardt, MD GERMANY Bertram Kasiske, MD USA
    8. 8. KDIGO Board of Directors <ul><li>David Harris, MD, AUSTRALIA </li></ul><ul><li>Michel Jadoul, BELGIUM </li></ul><ul><li>Vivekanand Jha, MD, INDIA </li></ul><ul><li>Suhnggwon Kim, MD, KOREA </li></ul><ul><li>Martin Kuhlmann, MD, GERMANY </li></ul><ul><li>Adeera Levin, MD, CANADA </li></ul><ul><li>Nathan Levin, MD, USA </li></ul><ul><li>Phillip K.T. Li, MD, HONG KONG </li></ul><ul><li>Zhi-Hong Liu, MD , CHINA </li></ul><ul><li>Francesco Locatelli, MD, ITALY </li></ul><ul><li>Alison MacLeod, MD, UK </li></ul><ul><li>Pablo Massari, MD, ARGENTINA </li></ul><ul><li>Peter McCullough, MD, USA </li></ul><ul><li>Rafique Moosa, MD, SOUTH AFRICA </li></ul><ul><li>Miguel C. Riella, MD, BRAZIL </li></ul><ul><li>Bernardo Rodriguez-Iturbe, MD, </li></ul><ul><li>VENEZUELA </li></ul><ul><li>Robert Schrier, MD USA </li></ul><ul><li>Trent Tipple, MD,TX Recipient, USA </li></ul><ul><li>Yusuke Tsukamoto, MD, JAPAN </li></ul><ul><li>Raymond Vanholder, MD, BELGIUM </li></ul><ul><li>Giancarlo Viberti, MD, UK </li></ul><ul><li>Theodor Vogels, MSW, NETHERLANDS </li></ul><ul><li>David Wheeler, MD, UK </li></ul><ul><li>Carmine Zoccali, MD, ITALY </li></ul>
    9. 9. Executive Committee Co-chairs: Kai-Uwe Eckardt Germany Bertram Kasiske United States Past co-chairs: Norbert Lameire Belgium Garabed Eknoyan United States Members: Adeera Levin Canada Nathan Levin United States Franceseco Locatelli Italy Alison MacLeod Scotland Miguel Riella Brazil Robert Schrier United States Yusuke Tsukamoto Japan Raymond Vanholder Belgium David Wheeler United Kingdom
    10. 10. Clinical Practice Guidelines
    11. 11. Guiding Principles for KDIGO Guideline Development <ul><li>Scientific and methodological rigor </li></ul><ul><li>Interdisciplinary approach </li></ul><ul><li>Independence of work groups </li></ul><ul><li>Transparency of the guideline development process </li></ul>
    12. 12. Grading: The Quality of the Evidence and the Strength of the Recommendation e.g. ( Grade 1C ) or ( Grade 2D ) ……(8 options) Plus option to include statements that are not graded <ul><li>2 components of final grade:  granularity and transparency </li></ul><ul><li>Although quality of evidence influences strength of recommendation, no direct link </li></ul><ul><li>“ Neutral“ alphanumeric code instead of terms that may be interpreted differently </li></ul>Quality of evidence High A Strength of recom-mendation 1 Corresponds to “strong“ in GRADE Moderate B Low C 2 Corresponds to “weak“ in GRADE Very low D
    13. 13. Published Clinical Practice Guidelines <ul><li>Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in CKD </li></ul><ul><ul><li>Published in Kidney International in April, 2008 </li></ul></ul><ul><li>Diagnosis, Evaluation, Prevention, and Treatment of CKD-MBD </li></ul><ul><ul><li>Published in Kidney International in July, 2009 </li></ul></ul><ul><li>Care of Kidney Transplant Recipients </li></ul><ul><ul><li>Published in the American Journal of Transplantation in October, 2009; Executive Summary published in Kidney International in December, 2009 </li></ul></ul>
    14. 14. Guidelines in Development <ul><li>Acute Kidney Injury </li></ul><ul><ul><li>Chairs: John Kellum & Norbert Lameire </li></ul></ul><ul><ul><li>Anticipated Publication: September, 2010 </li></ul></ul><ul><li>Glomerulonephritis </li></ul><ul><ul><li>Chairs: John Feehally & Dan Cattran </li></ul></ul><ul><ul><li>Anticipated Publication: December, 2010 </li></ul></ul><ul><li>Hypertension </li></ul><ul><ul><li>Chairs: Gavin Becker & David Wheeler </li></ul></ul><ul><ul><li>Anticipated Publication: July, 2011 </li></ul></ul>
    15. 15. Guidelines in Development <ul><li>Anemia in CKD </li></ul><ul><ul><li>Chairs: John McMurray and Patrick Parfrey </li></ul></ul><ul><ul><li>Initiate in March, 2010 </li></ul></ul><ul><ul><li>Anticipated Publication in 2011 </li></ul></ul><ul><li>CKD Classification and Treatment </li></ul><ul><ul><li>Chairs: Adeera Levin and Paul Stevens </li></ul></ul><ul><ul><li>Initiate in Summer of 2010 </li></ul></ul><ul><ul><li>Anticipated Publication in 2011/12 </li></ul></ul>
    16. 16. Controversies Conferences
    17. 17. 2010 KDIGO Controversies Conferences <ul><li>Drug Prescribing in Kidney Disease: </li></ul><ul><li>Initiative for Improved Dosing (May 2010) </li></ul><ul><li>Co-chairs: George Aronoff and Patrick Murray </li></ul><ul><li>  Cardiovascular Disease in CKD: What is it </li></ul><ul><li>and what can we do about it? (October 2010) </li></ul><ul><li>Co-chairs: Eberhard Ritz and Charles Herzog </li></ul><ul><li>  </li></ul>
    18. 18. 2011 Planned KDIGO Controversies Conferences <ul><li>Living Kidney Donor </li></ul><ul><li>(March 2011) </li></ul><ul><li>  </li></ul><ul><li>Alternative Dialysis Techniques </li></ul><ul><li>(October 2011) </li></ul>
    19. 19. Guideline Coordination
    20. 20. Collaborating Guideline Groups <ul><li>Canadian Society of Nephrology (CSN) Guidelines </li></ul><ul><li>Caring for Australians with Renal Impairment (CARI) Guidelines - ANZSN </li></ul><ul><li>United Kingdom Renal Association Guidelines </li></ul><ul><li>European Best Practice (EBPG) Guidelines – ERA/EDTA </li></ul><ul><li>Kidney Disease Outcomes Quality Initiative (KDOQI) Guidelines – NKF </li></ul><ul><li>ISN Guideline Committee </li></ul>
    21. 21. Guideline Coordination <ul><li>Liaison Task Force </li></ul><ul><li>Global Guideline Coordination Group </li></ul><ul><li>ISN/KDIGO Collaboration Group </li></ul>
    22. 22. Guideline Implementation
    23. 23. Guideline Implementation <ul><li>Publish Guidelines in multiple languages on KDIGO website and in regional journals </li></ul><ul><li>Commentaries from ISN, KDOQI, ERBP, UK-RA, CARI, and CSN </li></ul><ul><li>Develop professional education tools based on KDIGO Guidelines </li></ul><ul><li>KDIGO Implementation Task Force </li></ul>
    24. 24. Implementation Task Force <ul><li>The KDIGO Implementation Task Force is charged with promoting awareness, dissemination, adoption and clinical integration of KDIGO Clinical Practice Guidelines locally, around the world. </li></ul>
    25. 25. Implementation Task Force <ul><li>Task Force divided into 6 regions </li></ul><ul><li>Each Task Force Leader has designated Regional Representatives from the countries within their region </li></ul><ul><li>There will be different approaches to guideline dissemination depending on the region and on the country </li></ul>Type the Presentation Title here – Type the Presentation Subtitle here
    26. 26. KDIGO Implementation Task Force <ul><li>LEADER REGION </li></ul><ul><li>Yusuke Tsukamoto (Chair) Asia Pacific </li></ul><ul><li>Michelle Josephson North America </li></ul><ul><li>Miguel Riella Latin America </li></ul><ul><li>Michel Jadoul Western Europe </li></ul><ul><li>Andrzej Więcek Eastern Europe </li></ul><ul><li>Mona Al Rukhaimi Middle East/Africa </li></ul>
    27. 27. Implementation Task Force <ul><li>Activities: </li></ul><ul><li>Facilitate and increase the number of presentations on KDIGO guidelines at local, national, and regional meetings. </li></ul><ul><ul><li>Translate and submit guideline translations and executive summaries to regional journals for publication. </li></ul></ul>
    28. 28. <ul><li>Activities: </li></ul><ul><ul><li>Promote integration and adoption of guidelines into residency training programs. </li></ul></ul><ul><ul><li>Assist in developing commentaries / editorials on KDIGO Guidelines for publication in regional journals. </li></ul></ul><ul><ul><li>Communicate with regional healthcare administrators to promote adoption of practice guidelines. </li></ul></ul>Implementation Task Force
    29. 29. KDIGO Website
    30. 30. Website Resources <ul><li>KDIGO Guidelines: </li></ul><ul><ul><li>All published guidelines available </li></ul></ul><ul><ul><li>Recommendations translated into multiple languages </li></ul></ul><ul><ul><li>Slide presentations </li></ul></ul><ul><li>Reports from Controversies Conferences </li></ul><ul><ul><li>Published position statements </li></ul></ul><ul><ul><li>Conference presentations </li></ul></ul>
    31. 31. Website Resources <ul><li>Global Nephrology Guideline Database: </li></ul><ul><ul><li>Guideline Overviews by Organization </li></ul></ul><ul><ul><li>Guideline Summaries by Clinical Topic </li></ul></ul>
    32. 32. Thank you