Critical Appraisal of International Clinical Practice Guidelines in Kidney Transplantation Using the Appraisal of Guidelines for Research and Education (AGREE) II Tool: A Systematic Review

Background Whilst 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 (AGREE) II tool. Methods CPGs in Ktx and donation published between 2010 and 2017 were identified from MEDLINE, Embase, National Guideline Clearinghouse, NHS and NICE Evidence Searches, and the websites of transplant societies. Using AGREE II, 3 appraisers assessed the quality of CPGs. Interrater reliability was measured using the intraclass correlation coefficient (ICC). Results Searches identified 3,168 records and 115 CPGs were included. The highest scoring AGREE 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%), 'Rigour 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 modifications (18%). A small number were not recommended for future use (14%) or reviewers did not agree on recommending the CPG (5%). The overall mean CPG quality score was 4 out 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. Correspondence information: Corresponding Author: Katriona JM O'Donoghue, E-mail: kodonoghue@rcseng.ac.uk, Mailing address: Centre for Evidence in Transplantation, Clinical Effectiveness Unit, Royal College of Surgeons, 35-43 Lincoln's Inn Fields, London WC2A 3PE. Systematic review registration PROSPERO ID: CRD42015027356 AUTHORSHIP PAGE Authorship KO, RR, SK, JO, PM and LP were involved in the concept and design of the systematic review. KO and LP designed the search strategy. KO and RR screened search results for relevant full-texts and these were checked by LP. KO and RR performed the data extraction. All authors were involved in the critical appraisal of guidelines with AGREE II. KO wrote the initial drafts of the manuscript and these were revised by LP. All authors critically revised the final draft of the manuscript. KO 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. KO is guarantor. Disclosure All authors have completed the ICMJE uniform disclosure form at https://ift.tt/PN8RmS and the authors declare no conflicts of interest. Funding No funding received Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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