GRADE-ADOLOPMENT of nephrology clinical practice guidelines and creation of referral algorithms for Pakistan

Abstract

Objective: To develop evidence-based local clinical practice guidelines and primary care referral pathways for general physicians to help streamline the management of glomerular diseases and diabetes in chronic kidney disease patients in Pakistan.

Method: The study was conducted from October 2021 to February 2023 at the Centre for Clinical Best Practices, Aga Khan University Hospital, Karachi, in collaboration with the AKUH Section of Nephrology. Two source guidelines were selected by the local nephrologists after a thorough literature review on PubMed and Google Scholar. GRADE-ADOLOPMENT approach was used to adopt, adapt or exclude recommendations from the source guidelines in order to create the local clinical practice guidelines. Recommendations from the local clinical practice guidelines were used to create the primary care referral pathways.

Results: Management guidelines for glomerular diseases and diabetes in chronic kidney disease and two primary care referral pathways for the management and timely referral of the patients were created for general physicians to follow in Pakistan.

Conclusion: On the basis of two source guidelines, evidence-based local clinical practice guidelines and primary care referral pathways for general physicians were developed for general physicians in Pakistan for a smooth referral process.

Key Words: Nephrology, Diabetes, Renal Insufficiency, Chronic, Health Care