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National Collaborating Centre for Chronic Conditions (UK). Chronic Kidney Disease: National Clinical Guideline for Early Identification and Management in Adults in Primary and Secondary Care. London: Royal College of Physicians (UK); 2008 Sep. (NICE Clinical Guidelines, No. 73.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Cover of Chronic Kidney Disease

Chronic Kidney Disease: National Clinical Guideline for Early Identification and Management in Adults in Primary and Secondary Care.

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Appendix AEvidence-based clinical questions and literature searches

The questions below are listed in the order that the relevant sections appear in the guideline.

Question IDQuestion wordingStudy type filters usedDatabase and years
TEST 1What is the best diagnostic test to measure renal function in routine clinical practice?Systematic reviews, RCTs, cohort studies, diagnostic studiesMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008
TEST 4In adults with CKD, what is the biological and analytical variability in eGFR testing and what factors (including fasting) affect it?No filters, i.e. all study typesMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008
TEST 3What is the sensitivity and specificity of reagent strips for detecting protein and blood in the urine of patients?Systematic reviews, RCTs, observational studiesMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008
TEST 2What are the benefits in terms of accuracy and cost in measuring albumin:creatinine ratio versus protein:creatinine ratio to quantify proteinuria in adults with CKD?Systematic reviews, RCTs, observational studies, diagnostic studiesMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008
ULTRA 1What are the indications for renal ultrasound in adults with CKD?No filters, i.e. all study typesMedline 1966–2008
Cochrane 1800–2008
US Guidelines Clearinghouse (2007)
National Electronic Library for Health (2007)
National Institute of Health and Clinical Excellence Website (2007)
Health Technology Assessment Website (2007)
OUTS 1At what level of GFR are patient outcomes significantly affected? Does this change with age, gender, ethnicity or presence/absence of proteinuria?Systematic reviews, RCTs, observational studiesMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008
IDEN 1In adults, who should be tested for CKD?Systematic reviews, RCTs, observational studiesMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008
PROG 1What constitutes a significant decline in GFR?No filters, i.e. all study typesMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008
RISK 2Which factors are associated with progression of CKD?
  1. cardiovascular disease?
  2. acute kidney injury?
  3. obesity?
  4. smoking?
  5. urinary tract obstruction?
  6. ethnicity
  7. chronic use of NSAIDs
Systematic reviews, RCTs, observational studiesMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008
REFER 1What are the criteria for referral to specialist care?No filters, i.e. all study typesMedline 1966–2008
Cochrane 1800–2008
US Guidelines Clearinghouse (2007)
National Electronic Library for Health (2007)
National Institute of Health and Clinical Excellence Website (2007)
Health Technology Assessment Website (2007)
LIFE 1In adults with CKD, does improving lifestyle habits decrease progression of CKD?No filters, i.e. all study typesMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008
DIET 1Which dietary interventions are associated with improved renal outcomes in adults with CKD?No filters, i.e. all study typesMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008
BP 1In adults with proteinuric/nonproteinuric CKD, what are the optimal blood pressure ranges for slowing kidney disease progression, and for reducing cardiovascular disease risk and mortality?Systematic reviews, RCTs, observational studiesMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008
HYPR 1What are the most appropriate antihypertensive drugs to reduce the risk of progression of CKD and to decrease mortality in adults with CKD?Systematic reviews, RCTsMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008
MONIT 1In adults with CKD commencing an ACE inhibitor or ARB, what parameters of renal function should be monitored and how often? (What action threshold should be used for stopping treatments with an ACE inhibitor/ARB)?Systematic reviews, RCTs, observational studiesMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008
RISK 1In adults with CKD does the risk:benefit ratio of ACE inhibitors or ARBs change with increasing age?Systematic reviews, RCTs, observational studiesMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008
HYPR 2In adults with proteinuric or non-proteinuric CKD, does treatment with
  1. spironolactone alone,
  2. combinations of spironolactone and ACE inhibitors,
  3. combinations of spironolactone and ARBs, or
  4. combinations of spironolactone and ACE inhibitors and ARBs decrease mortality and reduce the risk of progression of CKD compared with placebo or other antihypertensive agents?
Systematic reviews, RCTsMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008
STAT 1In adults with CKD and proteinuria, do statins decrease proteinuria and decrease the risk of progression of CKD compared with other treatments or placebo?Systematic reviews, RCTsMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008
LIPID 1In adults with CKD and dyslipidaemia, do lipid lowering agents (statins, fibrates, fish oils) decrease cardiovascular disease risk and all cause mortality compared with placebo or each other?Systematic reviews, RCTsMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008
ANTI 1In adults with CKD, does antiplatelet and anticoagulant therapy reduce cardiovascular morbidity and mortality compared with placebo?Systematic reviews, RCTsMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008
URIC 1Does lowering uric acid with
  1. allopurinol
  2. uricosuric agents (probenecid, sulfinpyrazone)
  3. rasburicase (urate oxidase), decrease morbidity and mortality in adults with CKD and hyperuricaemia?
Systematic reviews, RCTsMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008
HAEM 1What are the adverse outcomes associated with isolated microscopic haematuria and how should it be managed in adults with CKD?No filters, i.e. all study typesMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008
BONE 1When should serum calcium, vitamin D, phosphate and intact parathyroid hormone levels be routinely measured in adults with CKD?Systematic reviews, RCTs, observational studiesMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008
BONE 2What are the risks and benefits of bisphosphonates for preventing osteoporosis in adults with CKD?No filters, i.e. all study typesMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008
BONE 3Which type of vitamin D supplementation, if any, should be used in CKD?Systematic reviews, RCTsMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008
EDUC 1What information, education, and support are needed for CKD patients and their carers to understand and cope with the diagnosis, treatment and outcome of CKD?No filters, i.e. all study typesMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008
TOOLS 1What tools for community management are needed for GPs and primary care workers to manage CKD?No filters, i.e. all study typesMedline 1966–2008
Embase 1980–2008
Cochrane 1800–2008
Cinahl 1982–2008

NOTE: The final cut-off date for all searches was 8 February 2008.

Copyright © 2008, Royal College of Physicians of London.

All rights reserved. No part of this publication may be reproduced in any form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner. Applications for the copyright owner’s written permission to reproduce any part of this publication should be addressed to the publisher.

Bookshelf ID: NBK51767

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