This is a review of the 5th edition Renal Association guidelines chapter on CKD-MBD. The current guideline was published in the period following release of the KDIGO guidelines which prompted changes in guidelines around the world. For this updated version, a systematic literature review was performed using www.pubmed.gov, focusing on the topics of:
Mineral bone disorder
Renal osteodystrophy
Hyperphosphat(a)emia
Calcium
PTH
Vascular calcification
Phosphate binder
The search covered the period from Dec 2009 to October 2013. Articles not written in English were not assessed. Articles available in abstract forms; letters; case reports; editorials or review articles were also excluded. Articles were assessed for relevance to the guideline topic, eligibility for inclusion in the evidence base for that guideline and methodological quality. Articles were considered of particular relevance if they were describing:
? Meta-analysis of several trials
? Cochrane systematic reviews
? Prospective randomized trials
? NICE clinical guidelines
As with other Renal Association Clinical Practice Guidelines, the modified GRADE (Grades of recommendation, assessment, development and evaluation) system is used throughout. This system defines both the strength of the recommendations and the level of evidence upon which each is based (1). It classifies recommendations as “strong” (Grade 1) or “weak” (Grade 2) based upon benefits, risks, burden and cost. The quality or level of evidence is designated as high (Grade A), moderate (Grade B), low (Grade C) or very low (D) depending on factors such as study design, directness of evidence and consistency of results.