Key result
Blood pressure guidelines in chronic kidney disease are overwhelmingly opinion-based due to a lack of high-quality clinical studies and should not replace a common sense clinical approach.
The authors propose that clinical guidelines in nephrology should be viewed as desirables rather than replacements for individualized clinical judgment.
CKD BP guidelines warrant cautious, individualized use; leaves open need for high-quality RCTs to inform recommendations.
The primary purpose of guidelines should be to improve patient care by providing an avenue for healthcare professionals to participate in the assessment of appropriate care, based on sound medical reasoning and robust scientific knowledge. Guidelines are usually meant to be evidence-based when they are derived from systemic reviews of the relevant literature. Nephrology as a medical subspeciality lags behind other clinical disciplines when it comes to availability of high-quality clinical studies with hard clinical outcomes. In the absence of robust clinical evidence, recommendations in renal guidelines are overwhelmingly opinion-based and reflect the experience of the various experts. Unfortunately, no guidelines are detailed enough to provide recommendations for individual patients with different types and severity of co-morbidities. We propose that guidelines should be viewed as desirables and should not replace a common sense clinical approach to patient care by an autonomously practicing competent clinician.
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Thuraisingham et al. (2009) conducted a review in Chronic Kidney Disease. Blood pressure guidelines was evaluated. Blood pressure guidelines in chronic kidney disease are overwhelmingly opinion-based due to a lack of high-quality clinical studies and should not replace a common sense clinical approach.
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