Kidney Disease: Improving Global Outcomes G LOBAL S CIENCE L OCAL C HANGE
2019 KDIGO L EADERSHIP KDIGO Co-Chairs : Michel Jadoul, Belgium Wolfgang Winkelmayer, USA Executive Committee: Mustafa Arici, Turkey Ikechi Okpechi, South Africa Tara Chang, USA Rukshana Shroff, UK John Davis , CEO, USA Laura Sola, Uruguay John Gill, Canada Paul Stevens, Secretary-Treasurer, UK Morgan Grams, USA Marcello Tonelli , Canada Fan Fan Hou, China Suzanne Watnick, USA Kunitoshi Iseki, Japan Angela Webster, Australia Magdalena Madero, Mexico David Wheeler, UK Jolanta Malyszko, Poland Christina Wyatt , USA
KDIGO S TAFF John Davis, NY Chief Executive Officer Danielle Green, CA Executive Director Michael Cheung, NY Chief Scientific Officer Melissa Thompson, IL Chief Operating Officer Amy Earley, MA Guideline Development Director Tanya Green, LA Communications Director Official Corporate Location: Brussels, Belgium
T HE KDIGO M ISSION Improving the care and outcomes of kidney disease patients worldwide through the development and implementation of global clinical practice guidelines.
KDIGO H ISTORY Clinical Practice Guidelines in Nephrology began in 1995 • Under the umbrella of DOQI/KDOQI by the US National Kidney Foundation (NKF) • Produced guidelines through 2002 Concept of Global Clinical Practice Guidelines explored in 2003 & 2004 • Concept included forming a new global organization • KDIGO was launched in 2004 • Incorporated in Belgium as a non-profit foundation • Continued to be managed by NKF under a service contract KDIGO grew through 2012 when it became independent • KDIGO became self governed and self financed • Led by active volunteers and a small staff • Over 1,000 clinicians and scientists have participated KDIGO is funded by many sources, is transparent and financially stable • No funding directly from industry for guidelines or updates • Funding is sought for general support, conferences, and implementation activities
KDIGO A IMS T O • Translate scientific advances into useful and practical clinical practice recommendations and observations. • Maintain and enhance its brand representing trusted and usable global scientific information. • Make the global science available and understandable to clinicians around the world. • Implement its work through local and regional programs taking into account cultural, economic, language, regulatory and environmental issues. • Adapt, simplify, prioritize and validate recommendations and observations for clinician use in everyday practice.
KDIGO’ S P ROGRAM A GENDA • Clinical Practice Guidelines • KDIGO’s core mission = Development, vetting, dissemination, and implementation of Guidelines • Guideline Updates • Evidence-based, not time-based, streamlined process makes quicker updates possible • Controversies Conferences • Conferences that examine significant topics in nephrology and related disciplines that are not fully resolved. Over 40 so far. Each results in a published Conference Report, usually in Kidney International . Often a Controversies Conference will prompt development of a guideline. • Implementation Summits • Gathers KOL’s from a country or region to discuss barriers and opportunities for implementation of KDIGO recommendations • Clinical Practice Conferences • Usually held through invitations from local nephrology societies • Educational Tools • Variety of formats, languages, electronic or print, resource driven
KDIGO Clinical Practice Guidelines
R EASONS FOR G LOBAL G UIDELINES • Keeping up with new science is difficult for busy clinicians who cannot read all the journals, monitor all the congress presentations and know the latest studies • Clinicians cannot be expected to judge study quality • Physicians and patients need practical, easily accessible recommendations to aid decisions • Disclosing gaps in evidence can stimulate research • KDIGO is a global leader in translational kidney science • KDIGO is not a society, accountable to members; it is accountable only to patients
KDIGO G UIDELINES A RE … • Based on a systematic review of existing evidence • Based on the best and latest information available • Designed to provide information and assist decision-making • Developed by a knowledgeable, multidisciplinary panel of global experts and representatives from key stakeholders • A forum for patient involvement as appropriate • Based on an explicit, scientifically rigorous and transparent process that minimizes distortions, biases, and conflicts of interest • Reflective of ratings of both the quality of evidence and the strength of the recommendations • Are reconsidered and revised as appropriate whenever important new evidence warrants modifications of recommendation Institute of Medicine. Clinical Practice Guidelines We Can Trust . 2011. http://www.iom.edu/Reports/2011/Clinical-Practice-Guidelines-We-Can-Trust.aspx
KDIGO G UIDELINES A RE N OT … • Intended to define a standard of care • To be interpreted as prescribing an exclusive course of management • Specific practice protocols • Intended to be regulatory in nature Healthcare professionals making use of KDIGO guidelines are responsible for making their own informed practice decisions using help from KDIGO and its global science analyses
KDIGO G UIDELINE P ROCESS • KDIGO has a Methods Committee continually updating and modernizing its scientific processes and rigor • Decisions on Guideline topics and timetables are made by the Executive Committee based on scientific need, the availability of evidence, and resources • Guideline updates follow a similar process and are becoming more frequent through modular design and electronic publishing • Additional topics will be added by the Executive Committee for new guidelines and the timing of updates • Goal of a KDIGO library of 20-25 “living” guidelines covering all topics in nephrology, constantly updated to ensure they are current
KDIGO G UIDELINE - L OCAL A DAPTATION • Science is global • Variations in practice inevitably and appropriately occur • Implementation takes into account the needs of individual patients, available resources, costs, and limitations unique to a country, region, institution or a type of practice • KDIGO partners with nephrology societies, governments, hospitals, etc. to adapt guidelines to local circumstances • Global guidelines are valuable for physicians, industry partners, and societies when engaging with ministries of health, regulatory agencies, and insurance bodies
KDIGO G UIDELINES Hepatitis C April 2008 Mineral Bone Disorder July 2009 Transplant Recipient Oct 2009 Acute Kidney Injury March 2012 Glomerulonephritis June 2012 Anemia August 2012 Blood Pressure in CKD November 2012 Diagnosis and Management of CKD January 2013 Lipid Management November 2013 CKD-MBD Update July 2017 Living Kidney Donors August 2017 Hepatitis C Update October 2018
U PCOMING KDIGO G UIDELINES Transplant Candidate Evaluation – Steve Chadban, Australia & Greg Knoll, Canada Publication date: Q3/Q4 2019 Glomerulonephritis Update – Jurgen Floege, Germany & Brad Rovin, USA Publication date: Q3/Q4 2020 Blood Pressure in CKD Update – Alfred Cheung, USA & Johannes Mann, Germany Publication date: Q3/Q4 2020 Diabetes in CKD – Ian DeBoer, USA & Peter Rossing, Denmark Publication date: Q1/Q2 2021
KDIGO G UIDELINES – M OST C ITED IN KI S UPPLEMENTS KDIGO Guidelines are the TOP FIVE MOST CITED ARTICLES in Kidney International Supplements
KDIGO Controversies Conferences
KDIGO C ONTROVERSIES C ONFERENCES 2018: 2014: • Dialysis Initiation, Modality Choice & Prescription • ADPKD • Coronary Artery & Valvular Diseases in CKD • Iron Management in CKD Potassium Management ADTKD • • Onco-Nephrology Nephropathic Cystinosis • • 2017: 2013: HIV Related Kidney Diseases CKD-MBD: Back to the Future • • • Heart Failure in CKD • Supportive Care • Blood Pressure in CKD 2004-12: • Glomerular Diseases • Diabetic Kidney Disease 2016: • Novel Techniques & Innovation in Blood Purification • Common Elements in Uncommon Kidney Diseases • Cardiovascular Disease in CKD • Challenges in the Conduct of Clinical Trials • Drug Prescribing in CKD: Initiative for Improved Dosing • CKD & Arrhythmias • Definition, Classification, and Prognosis in CKD • Optimal Management of Patients with Advanced CKD • Blood Pressure in CKD - Stage 5D 2015: • Methodology and Transparency • Coordination of Guidelines for Anemia in CKD • Diabetes & CKD • Care of the Transplant Recipient • Fabry Disease • Definition, Evaluation & Classification of Renal • Complement-Mediated Kidney Diseases Osteodystrophy • Gitelman Syndrome Definition & Classification of CKD in Adults Worldwide •
KDIGO C ONFERENCE R EPORTS - M OST C ITED & M OST R EAD IN KI The 2017 KDIGO conference report on “Screening, diagnosis, and management of patients The KDIGO conference with Fabry disease” is the report on “The definition, FOURTH MOST READ classification and prognosis ARTICLE in Kidney of CKD” is the MOST CITED International ARTICLE in Kidney International (658 times)
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