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Critical Appraisal of International Clinical Practice Guidelines in Kidney Transplantation Using the Appraisal of Guidelines for Research and Education II Tool

A Systematic Review

O'Donoghue, Katriona Jane Marie1; Reed, Rhiannon D.2; Knight, Simon R., MChir1,3; O'Callaghan, John M.1,3; Ayaz-Shah, Anam A.1; Hassan, Sevda4; Weissenbacher, Annemarie, MD3; Morris, Peter J., FRS1,3; Pengel, Liset H.M., PhD1,3

doi: 10.1097/TP.0000000000002255
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Background Although clinical practice guidelines (CPGs) are used for the development of local protocols in kidney transplantation (Ktx), the quality of their methodology is variable. This systematic review aimed to critically appraise international CPGs in all aspects of Ktx using the Appraisal of Guidelines for Research and Evaluation II tool.

Methods Clinical Practice Guidelines in Ktx and donation published between 2010 and 2017 were identified from MEDLINE, Embase, National Guideline Clearinghouse, National Health Service and National Institute for Health and Care Excellence Evidence Searches, and the websites of transplant societies. Using Appraisal of Guidelines for Research and Evaluation II, 3 appraisers assessed the quality of CPGs. Interrater reliability was measured using the intraclass correlation coefficient (ICC).

Results Searches identified 3168 records, and 115 CPGs were included. The highest scoring Appraisal of Guidelines for Research and Evaluation II domain was “scope and purpose” (80%; range, 30%-100%), followed by “clarity of presentation” (77%; range, 43%-98%), “editorial independence” (52%; range, 0%-94%), “rigor of development” (47%; range 6%-97%) and “stakeholder involvement” (41%; range, 11%-85%). The poorest scoring domain was “applicability” (31%; range, 3%-74%). Most CPGs were recommended for future use either with (63%) or without (18%) modifications. A small number (14%) were not recommended for future use or reviewers (5%) did not agree on recommending the CPG. The overall mean CPG quality score was 4 of 7 (range, 2-7). The mean ICC of 0.74 indicated substantial agreement between reviewers.

Conclusions The quality of international CPGs in Ktx was variable, and most CPGs lacked key aspects of methodological robustness and transparency. Improvements in methodology, patient involvement, and strategies for implementation are required.

Clinical Practice Guidelines in kidney transplantation are appraised in this systematic review looking at quality and interrater variability. Overall, most CPGs lacked key aspects of methodological robustness and transparency, which leaves room for significant improvement.

1 Centre for Evidence in Transplantation, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom.

2 University of Alabama at Birmingham, Comprehensive Transplant Institute, Birmingham, AL.

3 Nuffield Department of Surgical Sciences, University of Oxford John Radcliffe Hospital, Headington, Oxford, United Kingdom.

4 West London Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.

Received 19 February 2018. Revision received 29 March 2018.

Accepted 18 April 2018.

Correspondence: Katriona J.M. O'Donoghue, Centre for Evidence in Transplantation, Clinical Effectiveness Unit, Royal College of Surgeons, 35-43 Lincoln's Inn Fields, London WC2A 3PE, United Kingdom. (kodonoghue@rcseng.ac.uk).

The authors declare no funding or conflicts of interest.

Systematic review registration: PROSPERO ID: CRD42015027356.

K.O., R.R., S.K., J.O., P.M., and L.P. were involved in the concept and design of the systematic review. K.O. and L.P. designed the search strategy. K.O. and R.R. screened search results for relevant full texts, and these were checked by L.P., K.O., and R.R. performed the data extraction. All authors were involved in the critical appraisal of guidelines with AGREE II. K.O. wrote the initial drafts of the article and these were revised by L.P. All authors critically revised the final draft of the article. K.O. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. K.O. is the guarantor.

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

Kidney donation and transplantation are complex and evolving fields. Over 84 000 kidney transplants were estimated as carried out globally in 2015, based on the Global Observatory on Donation and Transplantation data, produced by the World Health Organization-Organización Nacional de Trasplantes (ONT) collaboration.1 Clinical practice guidelines (CPGs), defined as “systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances,”2 are essential for the development of protocols in transplant centers. Clinical Practice Guidelines should be evidence-based and of high quality to ensure these protocols reflect a good standard of clinical care and drive improvements in patient and clinical outcomes.

Variability in the quality of United Kingdom (UK) CPGs in all aspects of kidney transplantation (Ktx), however, has been previously identified.3 Using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, the methodological rigor and transparency of 13 UK CPGs published between 2010 and 2017 were critically assessed. United Kingdom CPGs scored satisfactorily overall but considerable variation in domain scores both within and across CPGs were identified. In another study, also using AGREE II, the quality of 13 CPGs for malignancy screening among solid organ transplant recipients was shown to demonstrate considerable variability and weakness in quality.4 The quality of 10 evidence-based CPGs and consensus statements focused on the screening and follow-up of living kidney donors published between 1996 and 2010 from Australia, United Kingdom, United States, Continental Europe, and Canada were also shown to lack methodological rigor when examined with AGREE, an earlier model of the AGREE II.5

The aim of this systematic review was to critically appraise international CPGs on all aspects of Ktx and donation. The AGREE II was used to assess the methodological rigor and transparency of the guideline development process.

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MATERIALS AND METHODS

Identification of CPGs

This systematic review of international CPGs was registered with the PROSPERO database of systematic review protocols (PROSPERO ID: CRD42015027356). The review was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The methods for this systematic review have been previously described.3 Briefly, relevant CPGs published from 2010 until April 2017 were identified via MEDLINE, Embase, and the National Guideline Clearinghouse and the National Health Service and National Institute for Health and Care Excellence evidence search platform. The full search strategy is provided in Materials and Methods (SDC,http://links.lww.com/TP/B574). Searches included keywords and Medical Subject Headings (MeSH) terms for Ktx, combined with terms for CPGs and were limited to the English language. In addition, 1 author (K.O.) manually searched the websites of international transplantation and nephrology societies, the United States Public Health Service and the World Health Organization. A full list of included societies is available in Materials and Methods (SDC, http://links.lww.com/TP/B574). Included CPGs from these searches were checked by a second author (L.P.).

Clinical practice guidelines and consensus statements published by international societies or experts, where the main aim of the article was to provide guidelines and/or recommendations specific to Ktx or kidney donation, were included. Where multiple versions of a CPG were identified, the most recent full publication was included. Articles not aimed specifically for Ktx were included if they comprised a chapter designated to Ktx. Two authors (K.O. and R.R.) independently reviewed the abstracts of all potentially eligible studies and made the final selection of studies to include based on their full texts. The same 2 authors independently extracted the following data from all included studies: author, year, title, organization, funding body, and whether patients had been involved in the preparation of the guideline. Patient involvement was considered met if the guideline explicitly described that a patient representative was included in the working group and contributed to the development of the CPG.

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Critical Appraisal With AGREE II

The AGREE II and the method used to critically appraise CPGs with AGREE II have been previously described in detail.3 Briefly, the AGREE II consists of 23 items organized into the following 6 quality domains: (i) scope and purpose, (ii) stakeholder involvement, (iii) rigor of development, (iv) clarity of presentation, (v) applicability, and (vi) editorial independence (see Materials and Methods, SDC,http://links.lww.com/TP/B574), in addition to 2 overall items. Each of the 23 items is scored on a 7-point Likert scale from 1 (strongly disagree) to 7 (strongly agree), and a domain score is calculated which involves summing up all of the scores of the individual items in a domain and scaling the total as a percentage of the maximum possible score for that domain (range, 0%-100%). For the first overall item, appraisers rate the quality of the entire CPG on the same Likert scale. For the second overall item, appraisers decide whether they would consider the CPG appropriate for future use, and answer with either “yes,” “yes with modifications”, or “no.”6

Each CPG was critically evaluated by 3 appraisers, including 1 transplant clinician and 2 methodologists using AGREE II. All appraisers completed the AGREE II Tutorial and Practice Exercise before commencing the critical appraisal of CPGs.

Appraisers were asked to review and where appropriate revise their initial ratings on any item where their score differed to the other 2 appraisers' scores by 5 points or higher (ie, 1 or 2 vs 7 and 1 vs 6). Initial and adjusted scores were calculated, and results presented are those of adjusted scores.

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Interrater Reliability

The intraclass correlation coefficient (ICC) was used to calculate interrater reliability.7 Two-way mixed model statistical analyses were performed using MedCalc for Windows, version 15.11.0.8 The ICC analysis included average measures for absolute agreement, and the degree of agreement was quantified using the following definitions: ICC less than 0.20, slight agreement; 0.21 to 0.40, fair agreement; 0.41 to 0.60, moderate agreement; 0.61 to 0.80, substantial agreement; 0.81 to 1.00, almost perfect agreement.9

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RESULTS

Included Studies

Systematic searches resulted in 3168 records, of which 115 CPGs were subsequently included in this systematic review.10-125 A literature flow diagram is shown in Figure 1.

FIGURE 1

FIGURE 1

Clinical practice guidelines were developed in the following countries; Australia (n = 35), Australia and New Zealand (n = 2), Brazil (n = 1), Canada (n = 4), Denmark (n = 1), Europe (n = 9), Europe and United States (n = 1), France (n = 2), Germany (n = 2), India (n = 2), International (n = 7), Iran (n = 1), Italy (n = 1), Japan (n = 3), Nordic Countries (n = 1), Spain (n = 6), United Kingdom (n = 16), United States (n = 20) and United States and Canada (n = 1). The majority of CPGs were from developed countries (97%) according to the International Statistical Institute World Bank Country Classifications,126 with a small minority from the developing countries, Brazil, Iran, and India (3%).

The highest number of CPGs were published in 2010 (n = 25), the remainder in 2011 (n = 19), 2012 (n = 9), 2013 (n = 15), 2014 (n = 13), 2015 (n = 15), 2016 (n = 16), and 2017 (n = 3).

Clinical practice guidelines were categorized according to their main topic, and most CPGs were published on living donation (n = 22). Other categories included infections (n = 18), recipient care (n = 15), recipient assessment (n = 9), deceased donation (n = 9), nutrition (n = 9), cardiovascular and lipid complications (n = 6), antibodies (n = 4), immunosuppression (n = 3), mixed aspects of transplantation including CPGs reporting on multiple aspects of transplantation (n = 6), imaging and biopsies (n = 5), and other aspects of transplantation (n = 9).

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Domain Scores

Domain scores and overall scores, including mean and ranges are shown in Table 1. The highest domain score across all CPGs was “scope and purpose” (80%; range, 30%-100%), followed by “clarity of presentation” (77%; range, 43%-98%), ‘editorial independence’ (52%; range, 0%-94%), “rigor of development” (47%; range, 6%-97%), “stakeholder involvement” (41%; range, 11%-85%), and “applicability” (31%; range, 3%-74%). Domain scores and overall scores for all CPGs are plotted in Figure 2. “Editorial independence” had the largest range of scores, whereas “clarity of presentation” had the smallest range.

TABLE 1

TABLE 1

FIGURE 2

FIGURE 2

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Overall Scores

The overall score ranged from 2 to 7 of 7 across CPGs. Fifty-one (44%) CPGs scored 5 or greater, whereas 64 (56%) scored less than 5.

Overall, 72 (63%) CPGs were recommended for future use with modifications, 21 (18%) were recommended for use without modifications, 16 (14%) were not recommended, and for 6 (5%) CPGs, appraisers did not agree whether the CPG should be recommended.

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Individual Item Scores

The highest and lowest scoring individual items are shown in Table 2. Mean compliance to AGREE items ranged from 28% to 86%. The largest range in appraiser scores for 1 item was for “a procedure for updating the guideline is provided” (10%-100%).

TABLE 2

TABLE 2

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Patient Involvement and Funding Body

Only 6 CPGs explicitly described in the guideline document that a patient representative was included in the working group and had contributed to the development of the guideline.

The majority of CPGs (n = 71) did not describe sources of funding for the development of the CPG. Of those that described funding sources (n = 44), the majority were funded by nonindustry (n = 27), followed by industry (n = 7), a mixture of industry and nonindustry (n = 4), whereas 6 CPGs stated that no funding was received.

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Interrater Reliability

The ICC across CPGs ranged from 0.28 to 0.92, indicating a fair to almost perfect level of interrater agreement. The average interrater reliability was substantial at 0.74.

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Original Scores

Ninety-three item score adjustments occurred across CPGs. Score adjustments most commonly occurred in the domain “editorial independence,” specifically for item 22 (the views of the funding body have not influenced the content of the guideline). Item score adjustments did not alter the average domain scores across CPGs, and there was only 1 difference in the order from highest to lowest scoring items. Item 10 (the methods for formulating the recommendations are clearly described) moved up from 15th position to 14th position and item 22 moved down from 14th position to 15th position. There were no adjustments across CPGs for the 2 overall ratings.

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DISCUSSION

Variability in the methodology and quality of 115 CPGs in Ktx was found in this systematic review. The highest scoring domain was “scope and purpose” followed by “clarity of presentation,” which is consistent with previous international studies where these domains have also scored highest.3-5,127,128 These 2 domains are important because they look at the overall language, structure, and format of the guideline as well as the overall aim, health questions, and target population. Simple, easy to understand CPGs appear to be the most accessed by clinicians and more likely to be implemented.129-131 The majority of CPGs adhered well to the items within these domains, indicating that guideline developers worldwide may understand the value and importance of these components. It may also be that the fulfillment of these components does not require a large amount of resources.132 It is encouraging that guideline developers are getting these aspects correct, as without adherence to these domains, CPGs may form cumbersome, complex documents that are likely ineffectual in clinical practice.

The poorest scoring domain was “applicability” which is consistent with previous studies.3-5,127 All items in this domain scored poorly across CPGs. The “applicability” domain examines whether CPGs have provided advice or tools for putting recommendations into practice, described facilitators and barriers in implementation, considered the resource implications of applying recommendations, and presented monitoring or auditing criteria. Unlike other domains, adhering to the aspects of “applicability” may require a larger amount of resources via the implementation of pilot testing, economic evaluations, educational tools, and patient leaflets.6 Useful CPGs however are those that can be adapted to clinical practice, not those that merely excel in theoretical content, and CPGs that are not clinically applicable arguably waste time and resources when recommendations are not used by the intended health practices.130 Decision making at the point of care may be compromised because without accessibility to reliable and replicable guidance, uncertainty remains. Treatment may be potentially delayed and inconsistencies emerge, which creates difficulty when assessing outcomes. A lack of proper consideration of the underlying evidence or poor clarity in presentation will also affect a clinician's confidence in the guidelines, meaning that adherence is less likely. Moreover, there is a potential harm to healthcare systems when limited resources are expended on prescribed interventions that are unaffordable, or compromise operating efficiency.133 Despite this, developers continuously overlook the applicability of CPGs. Organizations might need to consider refraining in developing CPGs unless they have the necessary funding and resources to address these aspects.

Comparatively, the domains “rigor of development” and “stakeholder involvement” scored slightly better, although still averaged poorly overall. Described as the strongest indicator for guideline quality, the domain “rigor of development” examines the processes used to gather and synthesize the evidence.127 Clinical practice guidelines based on poor-quality evidence risk the recommendation of suboptimal, ineffective, or even harmful practices.133 The use of systematic methods in the searching and selection of evidence are scrutinized in this domain, as well as reporting the strengths and limitations of evidence used to inform recommendations via specific instruments, such as Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the Jadad scale. Informal tools may also be used, but the essential component is transparently reporting all methods used in the identification, inclusion, and utilization of the evidence. Many CPGs are developed with low-level evidence or without the inclusion of evidence, instead based on expert opinion.134,135 The rationale behind this is that they provide continuity to clinical practice where there is a need for guidance and the evidence is poor. Reporting all methodological aspects is therefore particularly essential to allow the users of CPGs to judge the validity of the content.

Also examined within this domain is the undertaking of external reviews and including a procedure and date for CPG revision, items where CPGs again scored poorly. The external review is an important aspect as those individuals not directly involved in the process of CPG development have an opportunity to examine recommendations. Lack of awareness, familiarity, and agreement of CPGs have been identified as barriers to their usage and adherence to recommendations.131,136 The inclusion of clinicians as external reviewers may encourage those within their practice to be more engaged with the implementation of guidance.137 Involving those outside the working group may also help to ensure that recommendations are relevant, reliable, and free from bias. According to AGREE II, external reviewers should consist of both clinical and methodological experts. Also recommended is publicly documenting the methodology used, as well as all reviewer criticisms, and the rationale for any modifications that did or did not occur to ensure transparency.138

There does not appear to be a consensus on the timeframe for CPG review, possibly because this is largely dependent on the content of the CPG and how regularly new, relevant evidence materializes.139 Studies examining the validity of CPGs in healthcare show variable results where a fifth of CPGs developed in the Spanish National Health System were out of date within 5 years.140 Half of CPGs published by the US Agency for Healthcare Research and Quality were obsolete after 5.8 years, and 86% of CPGs developed by the UK National Institute for Health and Clinical Excellence were still up to date 3 years after publication.141,142 The challenge for CPG developers is to ensure recommendations are valid, reliable, and up to date without wasting time and resources in identifying new evidence if there is no significant change, or the evidence does not warrant changes to current recommendations.142 The Transplant Library is a resource that provides quick access to high-quality evidence that could warrant changes to recommendations.143 For improvements in this item, developers should document the proposed date for CPG review detailing clearly the intended methodology, monitor the literature regularly, and update recommendations when new evidence suggests the need for modification.

The poorest scoring item across CPGs was seeking the views and preferences of the target population, which is 1 of 3 items included in the domain “stakeholder involvement.” The importance of patient preferences to clinical decision making has gained steady momentum and has led to advocating the involvement of patient and public representatives in the development of CPGs.144,145 A collaborative approach is recommended which allows the formulation of CPGs that are not only evidence-based but that are more likely to be adhered to by patients and therefore useful in clinical practice. The incorporation of a patient representative in the working group and in the development of CPGs was examined in this systematic review. Disappointingly, very few CPGs included a patient representative. Similar findings are reported in a systematic review spanning 2 decades between 1980 and 2007 highlighting that little progress has been made with improving this area.127 The Guideline International Network provide a useful online toolkit which details practical support for obtaining patient perspectives via 3 main strategies: consultation, participation, and communication.146 Guideline developers would benefit from incorporating such examples in the development of CPGs to ensure they are clinically applicable to the target population.

The domain “editorial independence” examines competing interests declarations and whether recommendations may be biased by the views of funding bodies or CPG developers. Clinical practice guidelines performed moderately in this domain, and the majority of CPGs did not describe details of funding. The CPG developers may underestimate the importance of addressing and declaring all competing interests and financial aid. Alternatively, excluding this information may be a sinister way of concealing the exchange of professional or financial gains for the promotion of specific recommendations. Clinical practice guidelines are widely distributed and have the power to influence clinical practice protocols, and unethical or unsafe recommendations must not be put forward for personal or organizational gain. Preventing competing interests in CPG development is a difficult and complex task. Excluding individuals with conflicts of interest in the involvement of CPG development is a possible solution; however, this is dependent on self-reporting, and evidence suggests that many individuals are not transparent, or even aware of their own conflicts of interest.147 It may also be difficult to exclude certain individuals with conflicts of interest because their expertise is not replaceable.148 Similarly, considerable time and resources are involved in the development of CPGs, and funding may not be available from nonconflicting organizations. Conflicts of interest and involvement of funders in CPG development should be reduced as much as possible to avoid biased guidelines.148 The CPG users would benefit from explicit, publicly accessible details of funding and conflicts of interest, which will increase their confidence about the reliability of CPGs for clinical practice.

This systematic review has limitations. Included CPGs were published in English only, the majority of which were developed in Australia and the United States. Therefore, the overall mean results were largely influenced by the CPG development procedures in place in these countries. Systematic searches located CPGs published in journals; however, manual searches were constrained to include international transplantation societies that would be producers of CPGs. The majority of these societies were located in developed countries, indicating that the quality of CPGs in developing countries are likely underrepresented in this systematic review. A study that surveyed international members of The Transplantation Society on the uptake of a CPG on cytomegalovirus management in solid organ transplantation reported that 20% of respondents were from developing countries.149 It may be that CPGs from developing countries are sparse, and this community relies on CPGs published by other national and international organizations. A large portion of CPGs included in this systematic review were produced in 2010 and 2011 and could be considered out of date. However, because these CPGs have not been updated and are currently available for use in clinical practice, the inclusion of these CPGs is relevant to the overall quality of international CPGs. Clinical practice guidelines on all aspects of Ktx and kidney donation were included in the systematic review, enabling an extensive range of topic areas to be covered. However, because of this variability, recommendations could not be compared across CPGs.

A strength of the systematic review is the use of 3 appraisers for all CPGs, which included individuals with a methodological background and kidney transplant clinicians. The rationale for inclusion of both was to ensure that the examination and interpretation of CPGs was representative of differences in clinical and methodological opinion. Appraisals were completed individually and multiple appraisers with differing affiliations were used to limit the influence of confirmation bias. All appraisers completed the training module before appraising any CPGs and the ICC demonstrates that there was a good cohesion between all appraisers.

The AGREE II instrument incorporates specific criteria for all 23 items, however, is limited by a lack of guidance on how to make the overall assessments. Appraisers could have rated these differently depending on which aspects of CPG development they felt were most representative of overall CPG quality.127 There is also no cutoff to distinguish between high- and low-quality clinical practice guidelines, an aspect identified as important by many users.150 The number of items in each domain is not consistent and items attributed to “rigor of development” or “applicability” will have less of an effect on the overall domain score compared to items in the “editorial independence” domain. As with all critical appraisals, the AGREE II is also dependent on methodological reporting. CPG developers may have used utilized methods not described in the document.

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CONCLUSIONS

The quality of international CPGs in Ktx requires significant improvement. Only a small number of CPGs scored well overall and were recommended for future use without modifications. The majority scored poorly overall and required modification, and a small number were not recommended for future use. All CPGs demonstrated variability in domain and item scores with most performing well in the domains “scope and purpose” and “clarity of presentation” and poorly in the domain “applicability.” The CPG developers should pay closer attention to the components of the AGREE II and endeavor to incorporate them into CPGs. Many aspects could be easily improved without an additional burden on time and resources. High-quality CPGs will support evidence-based decision making and will ultimately lead to better outcomes for kidney transplant recipients.

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REFERENCES

1. Organ Donation and Transplantation Activities 2015. Global Observatory on Donation and Transplantation (GODT) data, produced by the WHO-ONT collaboration. Available from: http://www.transplant-observatory.org. Accessed October 31, 2017.
2. Institute of Medicine (US) Committee to Advise the Public Health Service on Clinical Practice Guidelines, Field MJ, Lohr KN, et al. Clinical Practice Guidelines: Directions for a New Program. Washington DC: National Academies Press US; 1990.
3. O'Donoghue KJM, Reed RD, Knight SR, et al. Systematic review of clinical practice guidelines in kidney transplantation. BJS Open. 2017;1:97–105.
4. Acuna SA, Huang JW, Scott AL, et al. Cancer screening recommendations for solid organ transplant recipients: a systematic review of clinical practice guidelines. Am J Transplant. 2017;17:103–114.
5. Tong A, Chapman JR, Wong G, et al. Screening and follow-up of living kidney donors: a systematic review of clinical practice guidelines. Transplantation. 2011;92:962–972.
6. Brouwers M, Kho ME, Browman GP, et al. AGREE II: Advancing guideline development, reporting and evaluation in healthcare. Can Med Assoc J. 2010;182:E839–E842.
7. Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86:420–428.
8. MedCalc Statistical Software version 15.11.0 MedCalc Software bvba. Ostend, Belgium; https://www.medcalc.org; 2016.
9. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–174.
10. Mackie F, CARI. The CARI guidelines. Potential child-bearing donors. Nephrology (Carlton). 2010;15(Suppl 1):S99–S100.
11. Munn S, CARI. The CARI guidelines. Assessment of donor kidney anatomy. Nephrology (Carlton). 2010;15(Suppl 1):S96–S98.
12. van Hardeveld E, Tong A, CARI. The CARI guidelines. Psychosocial care of living kidney donors. Nephrology (Carlton). 2010;15(Suppl 1):S80–S87.
13. Kanellis J, CARI. The CARI guidelines. Justification for living donor kidney transplantation. Nephrology (Carlton). 2010;15(Suppl 1):S72–S79.
14. Cohney S, Kanellis J, Howell M, et al. The CARI guidelines. Donor renal function. Nephrology (Carlton). 2010;15(Suppl 1):S137–S145.
15. Isbel N, CARI guidelines. The CARI guidelines. Donors at risk: obesity. Nephrology (Carlton). 2010;15(Suppl 1):S121–S132.
16. Ierino F, Boudville N, Kanellis J, et al. The CARI guidelines. Donors at risk: hypertension. Nephrology (Carlton). 2010;15(Suppl 1):S114–S120.
17. Ierino F, Kanellis J, CARI. The CARI guidelines. Donors at risk: haematuria. Nephrology (Carlton). 2010;15(Suppl 1):S111–S113.
18. Boudville N, Kanellis J, CARI. The CARI guidelines. Donors at risk: proteinuria. Nephrology (Carlton). 2010;15(Suppl 1):S106–S110.
19. Boudville N, Isbel N, CARI. The CARI guidelines. Donors at risk: impaired glucose tolerance. Nephrology (Carlton). 2010;15(Suppl 1):S133–S136.
20. Gibbons N, Nicol D, CARI. The CARI guidelines. Surgical techniques in living donor nephrectomy. Nephrology (Carlton). 2010;15(Suppl 1):S88–S95.
21. National Institute for Health and Clinical Excellence. Single-port laparoscopic nephrectomy Interventional procedures guidance [IPG414]. 2011. Available from: https://www.nice.org.uk/guidance/ipg414. Accessed August 9, 2015.
22. Compiled by a Joint Working Party of The British Transplantation Society and The Renal Association Joint Working Party. Living Donor Kidney Transplantation. Third ed. 2011. Available from: https://bts.org.uk. Accessed February 25, 2015.
23. Melcher ML, Blosser CD, Baxter-Lowe LA, et al. Dynamic challenges inhibiting optimal adoption of kidney paired donation: findings of a consensus conference. Am J Transplant. 2013;13:851–860.
24. Levi ME, Kumar D, Green M, et al. Considerations for screening live kidney donors for endemic infections: a viewpoint on the UNOS policy. Am J Transplant. 2014;14:1003–1011.
25. Tushla L, Rudow DL, Milton J, et al. Living-donor kidney transplantation: reducing financial barriers to live kidney donation—recommendations from a consensus conference. Clin J Am Soc Nephrol. 2015;10:1696–1702.
26. Moore DR, Serur D, Rudow DL, et al. Living donor kidney transplantation: improving efficiencies in live kidney donor evaluation—recommendations from a consensus conference. Clin J Am Soc Nephrol. 2015;10:1678–1686.
27. Tan JC, Gordon EJ, Dew MA, et al. Living donor kidney transplantation: facilitating education about live kidney donation—recommendations from a consensus conference. Clin J Am Soc Nephrol. 2015;10:1670–1677.
28. Waterman AD, Morgievich M, Cohen DJ, et al. Living donor kidney transplantation: improving education outside of transplant centers about live donor transplantation—recommendations from a consensus conference. Clin J Am Soc Nephrol. 2015;10:1659–1669.
29. LaPointe Rudow D, Hays R, Baliga P, et al. Consensus conference on best practices in live kidney donation: recommendations to optimize education, access, and care. Am J Transplant. 2015;15:914–922.
30. Rodrigue JR, Kazley AS, Mandelbrot DA, et al. Living donor kidney transplantation: overcoming disparities in live kidney donation in the US—recommendations from a consensus conference. Clin J Am Soc Nephrol. 2015;10:1687–1695.
31. Working Party of the British Transplantation Society. UK Guidelines for Living Organ Donation from Prisoners. 2015. Available from: https://bts.org.uk/wp-content/uploads/2016/09/04_BTS_Donation_Prisoners-1.pdf. Accessed August 9, 2015.
32. Gracey D. Kidney Health Australia CARI guidelines. HIV, HBV and HCV infection. 2011. Available from: http://www.CARI.org.au. Accessed March 11, 2016.
33. McTaggart S. Kidney Health Australia CARI guidelines. Paediatric recipient. 2011. Available from: http://www.CARI.org.au. Accessed March 11, 2016.
34. Mulley W. Kidney Health Australia CARI guidelines. Malignancy. 2011. Available from: http://www.CARI.org.au. Accessed March 11, 2016.
35. Pilmore H. Kidney Health Australia CARI guidelines. Cardiovascular Disease. 2011. Available from: http://www.CARI.org.au. Accessed April 21, 2016.
36. Russell C. Kidney Health Australia CARI guidelines. Obesity in renal transplantation. 2011. Available from: http://www.CARI.org.au. Accessed April 21, 2016.
37. Campbell C. Kidney Health Australia CARI guidelines. Diabetes Mellitus. 2011. Available from: http://www.CARI.org.au. Accessed April 21, 2016.
38. Dudley C, Harden P. Renal Association Clinical Practice Guideline on the assessment of the potential kidney transplant recipient. Nephron Clin Pract. 2011;118(Suppl 1):c209–c224.
39. Guideline development group. Clinical Practice Guideline on management of patients with diabetes and chronic kidney disease stage 3b or higher (eGFR <45 mL/min). Nephrol Dial Transplant. 2015;30(Suppl 2):ii1–ii142.
40. Segall L, Nistor I, Pascual J, et al. Criteria for and appropriateness of renal transplantation in elderly patients with end-stage renal disease: a literature review and position statement on behalf of the European Renal Association-European Dialysis and Transplant Association Descartes Working Group and European Renal Best Practice. Transplantation. 2016;100:e55–e65.
41. Mackie F, CARI. The CARI guidelines. Donor-specific transfusions. Nephrology (Carlton). 2010;15(Suppl 1):S101–S105.
42. Knoll GA, Blydt-Hansen TD, Campbell P, et al. Canadian Society of Transplantation and Canadian Society of Nephrology commentary on the 2009 KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Kidney Dis. 2010;56:219–246.
43. Saif I, Adkins A, Kewley V, et al. Routine and emergency management guidelines for the dental patient with renal disease and kidney transplant. Part 1. Dent Update. 2011;38:179–182, 185–186.
44. Saif I, Adkins A, Kewley V, et al. Routine and emergency management guidelines for the dental patient with renal disease and kidney transplant. Part 2. Dent Update. 2011;38:245–248, 250–251.
45. Chadban SJ, Barraclough KA, Campbell SB, et al. KHA-CARI guideline: KHA-CARI adaptation of the KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients. 2012. Available from: http://www.CARI.org.au. Accessed January 11, 2016.
46. Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Inter. 2012;2(Suppl):337–414.
47. Pascual J, Alonso A, Burgos D, et al. Grupo Español de Consenso sobre disfunción renal crónica en pacientes. Chronic renal dysfunction in kidney transplant recipients. Consensus Document. Spanish Consensus Group on Renal Dysfunction in Kidney Transplantation Patients. Nefrologia. 2012;32(Suppl 2):1–28.
48. Expert Panel on Urologic Imaging, Taffel MT, Nikolaidis P, et al. ACR appropriateness Criteria® renal transplant dysfunction. J Am Coll Radiol. 2017;14:S272–S281.
49. Hornum M, Lindahl JP, von Zur-Mühlen B, et al. Diagnosis, management and treatment of glucometabolic disorders emerging after kidney transplantation: a position statement from the Nordic Transplantation Societies. Transpl Int. 2013;26:1049–1060.
50. Compiled by a Working Party of The British Transplantation Society. Management of the Failing Kidney Transplant. 2014. Available from: https://bts.org.uk. Accessed February 25, 2015.
51. Huprikar S, Danziger-Isakov L, Ahn J, et al. Solid organ transplantation from hepatitis B virus-positive donors: consensus guidelines for recipient management. Am J Transplant. 2015;15:1162–1172.
52. Morrone LF, Bolasco P, Camerini C, et al. Vitamin D in patients with chronic kidney disease: a position statement of the Working Group “Trace Elements and Mineral Metabolism” of the Italian Society of Nephrology. J Nephrol. 2016;29:305–328.
53. Vaccination guidelines in patients with chronic kidney disease and renal transplant recipients travelling abroad. Ind J Nephrol. 2016;26(Suppl 1):S26–S28.
54. Guidelines for vaccination in kidney transplant recipients. Ind J Nephrol. 2016;26(Suppl 1):S19–S25.
55. Neuberger JM, Bechstein WO, Kuypers DR, et al. Practical recommendations for long-term management of modifiable risks in kidney and liver transplant recipients: a guidance report and clinical checklist by the Consensus on Managing Modifiable Risk in Transplantation (COMMIT) Group. Transplantation. 2017;101(4S Suppl 2):S1–S56.
56. Baker RJ, Mark PB, Patel RK, et al. Post-Operative Care in the Kidney Transplant Recipient. 2017. Available from: https://bts.org.uk. Accessed March 21, 2017.
57. British Thoracic Society Standards of Care Committee and Joint Tuberculosis Committee, Milburn H, Ashman N, et al. Guidelines for the prevention and management of Mycobacterium tuberculosis infection and disease in adult patients with chronic kidney disease. Thorax. 2010;65:557–570.
58. Goodman D. Kidney Health Australia CARI guidelines. Treatment of cytomegalovirus disease in renal transplant recipients. 2011. Available from: http://www.CARI.org.au. Accessed March 11, 2016.
59. Pussell BA. Kidney Health Australia CARI guidelines. Prophylaxis for cytomegalovirus infection in patients following renal transplantation. 2011. Available from: http://www.CARI.org.au. Accessed April 21, 2016.
60. Pilmore H. Kidney Health Australia CARI guidelines. Diagnostic tests for Cytomegalovirus in renal transplantation. 2011. Available from: http://www.CARI.org.au. Accessed April 21, 2016.
61. Pilmore H. Kidney Health Australia CARI guidelines. Pre-emptive treatment of Cytomegalovirus. 2011. Available from: http://www.CARI.org.au. Accessed April 21, 2016.
62. de la Torre-Cisneros J, Fariñas MC, Castón JJ, et al. GESITRA-SEIMC/REIPI recommendations for the management of cytomegalovirus infection in solid-organ transplant patients. Enferm Infecc Microbiol Clin. 2011;29:735–758.
63. British Transplantation Society. The Prevention and Management of CMV Disease after Solid Organ Transplantation. Third ed. 2011: Available from: https://bts.org.uk. Accessed August 9, 2015.
64. Singh N, Huprikar S, Burdette SD, et al. Donor-derived fungal infections in organ transplant recipients: guidelines of the American Society of Transplantation, infectious diseases community of practice. Am J Transplant. 2012;12:2414–2428.
65. Razonable RR, Humar A, AST Infectious Diseases Community of Practice. Cytomegalovirus in solid organ transplantation. Am J Transplant. 2013;13(Suppl 4):93–106.
66. Parasuraman R, Julian K. AST Infectious Diseases Community of Practice. Urinary tract infections in solid organ transplantation. Am J Transplant. 2013;13(Suppl 4):327–336.
67. Hirsch HH, Randhawa P. AST infectious diseases community of practice. BK polyomavirus in solid organ transplantation. Am J Transplant. 2013;13(Suppl 4):179–188.
68. Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt). 2013;14:73–156.
69. AIDS Working Group (GESIDA) of the Spanish Society of InfectiousDiseases and Clinical Microbiology (SEIMC), Spanish Society of Nephrology (S.E.N.), Spanish Society of Clinical Chemistry and Molecular Pathology (SEQC), et al. Consensus document on the management of renal disease in HIV-infected patients. Nefrologia. 2014;34(Suppl 2):1–81.
70. Lucas GM, Ross MJ, Stock PG, et al. Clinical practice guideline for the management of chronic kidney disease in patients infected with HIV: 2014 update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2014;59:e96–e138.
71. Vidal E, Cervera C, Cordero E, et al. Management of urinary tract infection in solid organ transplant recipients: consensus statement of the Group for the Study of Infection in Transplant Recipients (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Network for Research in Infectious Diseases (REIPI). Enferm Infecc Microbiol Clin. 2015;33:679.e1–679.e21.
72. Compiled by a Working Party of The British Transplantation Society. Kidney & Pancreas Transplantation in Patients with HIV. Second ed. 2015. Available from: https://bts.org.uk. Accessed August 9, 2015.
73. Antimicrobial prophylaxis for Pneumocystis jiroveci pneumonia (PCP) after solid organ transplantation (SOT). 2015. Available from: https://www.cincinnatichildrens.org. Accessed April 5, 2016.
74. Yamamoto S, Shigemura K, Kiyota H, et al. Essential Japanese guidelines for the prevention of perioperative infections in the urological field: 2015 edition. Int J Urol. 2016;23:814–824.
75. Westphal GA, Caldeira Filho M, Vieira KD, et al. Guidelines for potential multiple organ donors (adult). Part III: organ-specific recommendations. Rev Bras Ter Intensiva. 2011;23:410–425.
76. Wunderlich H, Brockmann JG, Voigt R, et al. DTG procurement guidelines in heart beating donors. Transpl Int. 2011;24:733–757.
77. Compiled by a Working Party of The British Transplantation Society. Transplantation from deceased donors after circulatory death. 2013. Available from: https://bts.org.uk. Accessed February 25, 2015.
78. Antoine C, Mourey F, Prada-Bordenave E. Steering committee on DCD program. How France launched its donation after cardiac death program. Ann Fr Anesth Reanim. 2014;33:138–143.
79. Lledo-Garcia E, Riera L, Passas J, et al. Spanish consensus document for acceptance and rejection of kidneys from expanded criteria donors. Clin Transplant. 2014;28:1155–1166.
80. Chen J, Fink M, Pleass H, Verran D, Crawford M, Allen R. Surgical Technique for Deceased Donor Abdominal Organ Procurement. ATCA-TSANZ Guidelines G003/2015. 2015. Available from: http://www.tsanz.com.au. Accessed January 20, 2016.
81. Kotloff RM, Blosser S, Fulda GJ, et al. Management of the potential organ donor in the ICU: Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Consensus Statement. Crit Care Med. 2015;43:1291–1325.
82. The Transplantation Society of Australia and New Zealand. Clinical Guidelines for Organ Transplantation from Deceased Donors Version 1.0—April 2016. 2016. Available from: http://www.tsanz.com.au. Accessed April 21, 2016.
83. van Heurn LW, Talbot D, Nicholson ML, et al. Recommendations for donation after circulatory death kidney transplantation in Europe. Transpl Int. 2016;29:780–789.
84. Chadban S, Chan M, Fry K, et al. The CARI guidelines. Nutritional management of dyslipidaemia in adult kidney transplant recipients. Nephrology (Carlton). 2010;15(Suppl 1):S62–S67.
85. Chadban S, Chan M, Fry K, et al. The CARI guidelines. Nutritional management of hypertension in adult kidney transplant recipients. Nephrology (Carlton). 2010;15(Suppl 1):S56–S61.
86. Chadban S, Chan M, Fry K, et al. The CARI guidelines. Nutritional management of overweight and obesity in adult kidney transplant recipients. Nephrology (Carlton). 2010;15(Suppl 1):S52–S55.
87. Chadban S, Chan M, Fry K, et al. The CARI guidelines. Nutritional management of hypophosphataemia in adult kidney transplant recipients. Nephrology (Carlton). 2010;15(Suppl 1):S48–S51.
88. Chadban S, Chan M, Fry K, et al. The CARI guidelines. Nutritional interventions for the prevention of bone disease in kidney transplant recipients. Nephrology (Carlton). 2010;15(Suppl 1):S43–S47.
89. Chadban S, Chan M, Fry K, et al. The CARI guidelines. Nutritional management of anaemia in adult kidney transplant recipients. Nephrology (Carlton). 2010;15(Suppl 1):S40–S42.
90. Chadban S, Chan M, Fry K, et al. The CARI guidelines. Nutritional management of diabetes mellitus in adult kidney transplant recipients. Nephrology (Carlton). 2010;15(Suppl 1):S37–S39.
91. Chadban S, Chan M, Fry K, et al. The CARI guidelines. Food safety recommendations for adult kidney transplant recipients. Nephrology (Carlton). 2010;15(Suppl 1):S35–S36.
92. Chadban S, Chan M, Fry K, et al. The CARI guidelines. Protein requirement in adult kidney transplant recipients. Nephrology (Carlton). 2010;15(Suppl 1):S68–S71.
93. Dieperink H, Christensen JH, Feldt-Rasmussen B, et al. Danish guidelines for lipid-lowering treatment in patients with chronic renal failure. Dan Med J. 2014;61:C4843.
94. Lentine KL, Costa SP, Weir MR, et al. Cardiac disease evaluation and management among kidney and liver transplantation candidates: a scientific statement from the American Heart Association and the American College of Cardiology Foundation: endorsed by the American Society of Transplant Surgeons, American Society of Transplantation, and National Kidney Foundation. Circulation. 2012;126:617–663.
95. Kidney Disease: Improving Global Outcomes (KDIGO) Lipid Work Group. KDIGO Clinical Practice Guideline for Lipid Management in Chronic Kidney Disease. Kidney Inter. 2013;3(Suppl):259–305.
96. Pilmore H. Kidney Health Australia CARI guidelines. Cardiovascular disease: revascularisation. 2013. Available from: http://www.CARI.org.au. Accessed May 19, 2016.
97. Dogra G. Kidney Health Australia CARI guidelines. Medical management of coronary artery disease (excluding lipid-lowering therapy). 2012. Available from: http://www.CARI.org.au. Accessed May 19, 2016.
98. Roberts M. Kidney Health Australia CARI guidelines. Heart Failure. 2013. Available from: http://www.CARI.org.au. Accessed May 19, 2016.
99. Tait BD, Süsal C, Gebel HM, et al. Consensus guidelines on the testing and clinical management issues associated with HLA and non-HLA antibodies in transplantation. Transplantation. 2013;95:19–47.
100. Compiled by a Working Party of The British Transplantation Society. Guidelines for Antibody Incompatible Transplantation. Third ed. 2016. Available from: https://bts.org.uk/wp-content/uploads/2016/09/02_BTS_Antibody_Guidelines-1.pdf. Accessed September 22, 2016.
101. British Society for Histocompatibility & Immunogenetics and British Transplantation Society. The detection and characterisation of clinically relevant antibodies in allotransplantation. 2014. Available from: https://bts.org.uk/wp-content/uploads/2016/09/06_BTS_BSHI_Antibodies-1.pdf. Accessed February 25, 2015.
102. Shehata N, Palda VA, Meyer RM, et al. The use of immunoglobulin therapy for patients undergoing solid organ transplantation: an evidence-based practice guideline. Transfus Med Rev. 2010;24(Suppl 1):S7–S27.
103. Harrison JJ, Schiff JR, Coursol CJ, et al. Generic immunosuppression in solid organ transplantation: a Canadian perspective. Transplantation. 2012;93:657–665.
104. Caillard S, Moulin B, Buron F, et al. Advagraf®, a once-daily prolonged release tacrolimus formulation, in kidney transplantation: literature review and guidelines from a panel of experts. Transpl Int. 2016;29:860–869.
105. Shipkova M, Hesselink DA, Holt DW, et al. Therapeutic drug monitoring of everolimus: a consensus report. Ther Drug Monit. 2016;38:143–169.
106. Riccabona M, Avni FE, Damasio MB, et al. ESPR Uroradiology Task Force and ESUR Paediatric Working Group—Imaging recommendations in paediatric uroradiology, part V: childhood cystic kidney disease, childhood renal transplantation and contrast-enhanced ultrasonography in children. Pediatr Radiol. 2012;42:1275–1283.
107. Roberts I, Furness P, Cook T, on behalf of the College’s Specialty Advisory Committee on Cellular Pathology and the Cancer Services Working Group. Tissue pathway for medical renal biopsies [G061]. 2013. Available from: https://www.rcpath.org/asset/AEAF873A-694A-4435-9C82E2773C1343F5. Accessed August 9, 2015.
108. American College of Radiology (ACR), Society for Pediatric Radiology (SPR), Society of Radiologists in Ultrasound (SRU), American Institute of Ultrasound in Medicine (AIUM). AIUM practice guideline for the performance of an ultrasound examination of solid-organ transplants. J Ultrasound Med. 2014;33:1309–1320.
109. Pisarski P, Schleicher C, Hauser I, et al. German recommendations for pretransplantation donor kidney biopsies. Langenbecks Arch Surg. 2016;401:133–140.
110. Terminology and Diagnostic Criteria Committee, Japan Society of Ultrasonics in Medicine. Standard method for ultrasound evaluation of renal arterial lesions. J Med Ultrason (2001). 2016;43:45–62.
111. European Renal Best Practice Transplantation Guideline Development Group. ERBP Guideline on the management and evaluation of the kidney donor and recipient. Nephrol Dial Transplant. 2013;28(Suppl 2):ii1–ii71.
112. Karam G, Kälble T, Alcaraz A, et al. Guidelines on Renal Transplantation. 2014. Available from: http://uroweb.org. Accessed January 19, 2016.
113. Nafar M, Firoozan A, Poor-Reza-Gholi F, et al. Kidney donor and recipient perioperative evaluation. Iran J Kidney Dis. 2014;8:13–24.
114. Cantarovich M, Blydt-Hansen TD, Gill J, et al. Canadian forum on combined organ transplantation. Transplantation. 2016;100:1339–1348.
115. European Directorate for the Quality of Medicines & HealthCare. Guide to the quality and safety of organs for transplantation. 6th ed. 2016. Available from: https://www.edqm.eu/en. Accessed October 14, 2016.
116. Abramowicz D, Hazzan M, Maggiore U, et al. Does pre-emptive transplantation versus post start of dialysis transplantation with a kidney from a living donor improve outcomes after transplantation? A systematic literature review and position statement by the Descartes Working Group and ERBP. Nephrol Dial Transplant. 2016;31:691–697.
117. Taylor CM, Machin S, Wigmore SJ, et al. Working party from the Renal Association, the British Committee for Standards in Haematology and the British Transplantation Society. Clinical practice guidelines for the management of atypical haemolytic uraemic syndrome in the United Kingdom. Br J Haematol. 2010;148:37–47.
118. Torregrosa JV, Bover J, Cannata Andía J, et al. Spanish Society of Nephrology recommendations for controlling mineral and bone disorder in chronic kidney disease patients (S.E.N.-M.B.D.). Nefrologia. 2011;31(Suppl 1):3–32.
119. Savige J, Gregory M, Gross O, et al. Expert guidelines for the management of Alport syndrome and thin basement membrane nephropathy. J Am Soc Nephrol. 2013;24:364–375.
120. Fukagawa M, Yokoyama K, Koiwa F, et al. Clinical practice guideline for the management of chronic kidney disease-mineral and bone disorder. Ther Apher Dial. 2013;17:247–288.
121. Baumgartner MR, Hörster F, Dionisi-Vici C, et al. Proposed guidelines for the diagnosis and management of methylmalonic and propionic acidemia. Orphanet J Rare Dis. 2014;9:130.
122. Jelaković B, Nikolić J, Radovanović Z, et al. Consensus statement on screening, diagnosis, classification and treatment of endemic (Balkan) nephropathy. Nephrol Dial Transplant. 2014;29:2020–2027.
123. Wechalekar AD, Gillmore JD, Bird J, et al. Guidelines on the management of AL amyloidosis. Br J Haematol. 2015;168:186–206.
124. Loirat C, Fakhouri F, Ariceta G, et al. An international consensus approach to the management of atypical hemolytic uremic syndrome in children. Pediatr Nephrol. 2016;31:15–39.
125. Newell KA, Formica RN, Gill JS, et al. Integrating APOL1 gene variants into renal transplantation: considerations arising from the American Society of Transplantation Expert Conference. Am J Transplant. 2017;17:901–911.
126. International Statistical Institute. https://www.isi-web.org/index.php. Accessed November 7, 2017.
127. Alonso-Coello P, Irfan A, Solà I, et al. The quality of clinical practice guidelines over the last two decades: a systematic review of guideline appraisal studies. Qual Saf Health Care. 2010;19:e58.
128. Burda BU, Chambers AR, Johnson JC. Appraisal of guidelines developed by the World Health Organization. Public Health. 2014;128:444–474.
129. Francke AL, Smit MC, de Veer AJ, et al. Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC Med Inform Decis Mak. 2008;8:38.
130. Sola I, Carrasco JM, Díaz Del Campo P, et al. Attitudes and perceptions about clinical guidelines: a qualitative study with Spanish physicians. PLoS One. 2014;9:e86065.
131. Sinuff T, Eva KW, Meade M, et al. Clinical practice guidelines in the intensive care unit: a survey of Canadian clinicians' attitudes. Can J Anaesth. 2007;54:728–736.
132. Lytras T, Bonovas S, Chronis C, et al. Occupational Asthma guidelines: a systematic quality appraisal using the AGREE II instrument. Occup Environ Med. 2014;71:81–86.
133. Woolf SH, Grol R, Hutchinson A, et al. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999;318:527–530.
134. Venkatesh AK, Savage D, Sandefur B, et al. Systematic review of emergency medicine clinical practice guidelines: Implications for research and policy. PLoS One. 2017;12:e0178456.
135. Atkins D, Eccles M, Flottorp S, et al. Systems for grading the quality of evidence and the strength of recommendations I: critical appraisal of existing approaches The GRADE Working Group. BMC Health Serv Res. 2004;4:38.
136. Cabana MD, Rand CS, Powe NR, et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282:1458–1465.
137. Lowson K, Jenks M, Filby A, et al. Examining the implementation of NICE guidance: cross-sectional survey of the use of NICE interventional procedures guidance by NHS Trusts. Implement Sci. 2015;10:93.
138. Graham R, Mancher M, Wolman DM, et al. Clinical Practice Guidelines We Can Trust. Washington DC: National Academies Press US; 2011.
139. Alonso-Coello P, Martínez García L, Carrasco JM, et al. The updating of clinical practice guidelines: insights from an international survey. Implement Sci. 2011;6:107.
140. Martínez García L, Sanabria AJ, García Alvarez E, et al. The validity of recommendations from clinical guidelines: a survival analysis. CMAJ. 2014;186:1211–1219.
141. Alderson LJ, Alderson P, Tan T. Median life span of a cohort of National Institute for Health and Care Excellence clinical guidelines was about 60 months. J Clin Epidemiol. 2014;67:52–55.
142. Shekelle PG, Ortiz E, Rhodes S, et al. Validity of the Agency for Healthcare Research and Quality clinical practice guidelines: how quickly do guidelines become outdated? JAMA. 2001;286:1461–1467.
143. Transplant Library. http://www.transplantlibrary.com. Accessed November 7, 2017.
144. Umscheid CA. Should guidelines incorporate evidence on patient preferences? J Gen Intern Med. 2009;24:988–990.
145. Rashid A, Thomas V, Shaw T, et al. Patient and public involvement in the development of healthcare guidance: an overview of current methods and future challenges. Patient. 2017;10:277–282.
146. 147 G-I-N PUBLIC Toolkit: Patient and Public Involvement in Guidelines. http://www.g-i-n.net/document-store/working-groups-documents/g-i-n-public/toolkit/toolkit-2015/view. Published August, 2012. Updated October, 2015. Accessed September 20, 2017.
147. Choudhry NK, Stelfox HT, Detsky AS. Relationships between authors of clinical practice guidelines and the pharmaceutical industry. JAMA. 2002;287:612–617.
148. Graham T, Alderson P, Stokes T. Managing conflicts of interest in the UK National Institute for Health and Care Excellence (NICE) clinical guidelines programme: qualitative study. PLoS One. 2015;10:e0122313.
149. Le Page AK, Jager MM, Kotton CN, et al. International survey of cytomegalovirus management in solid organ transplantation after the publication of consensus guidelines. Transplantation. 2013;95:1455–1460.
150. Hoffmann-Eßer W, Siering U, Neugebauer EAM, et al. Is there a cut-off for high-quality guidelines? A systematic analysis of current guideline appraisals using the AGREE II instrument. J Clin Epidemiol. 2018;95:120–127.

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