Over the past decade, Kidney Disease: Improving Global Outcomes (KDIGO) has established as a leading global force in making observations about the practice of kidney health care and in synthesizing recommendations for best practices. This has occurred through staging Controversies Conferences with global experts and practitioners on relevant topics in kidney health, developing Clinical Practice Guidelines, and building a portfolio of Implementation Programs through which the products from the aforementioned two activities are interpreted and discussed in the local or regional context. All these activities are based on the premise articulated in KDIGO’s mission statement: to improve the health of patients with kidney diseases.
We see KDIGO continuing to be innovative and creative. We aim to establish a library of 20 to 25 guidelines that cover most aspects of kidney health. These guidelines will provide vital information to clinicians around the world who care for patients with kidney disease. Furthermore, our vision is that KDIGO Guidelines will always be current. As we are doing now, we shall continue to devote efforts and resources to the challenge of updating our guidelines in an ongoing fashion rather than in a discontinuous manner. This requires a paradigm change in the operative approach toward evidence surveillance, appraisal, interpretation, and dissemination.
Our future will involve working with an electronic guideline publishing platform, MAGICApp (Figure 1) where guideline recommendations, their rationale, and the underlying meta-analyzed data are stored in modular form. As such, when new data prompt an update of a single recommendation, the corresponding module can be modified and then reloaded in the system, thus ensuring currency of the complete guideline. KDIGO will continue to lead nephrology in using novel technology like this. This modular updating process will be faster, cheaper, and less labor intensive than before because it builds on work performed by prior guidelines. This can be achieved while still maintaining the scientific rigor that has served as the foundation of our reputation. The guideline Work Group, an independent Evidence Review Team, and a public commenting phase will remain critically essential in preserving the integrity of our work as we leverage this electronic platform to better streamline and simplify our guideline development efforts.
After a guideline is published, a few of the Work Group members will participate in ongoing evidence surveillance efforts (Figure 2). When new studies are found, KDIGO leadership and the appropriate guideline Work Groups will be informed and these Work Group members will determine what the new evidence means in the context of the existing guideline. If it is significant, the KDIGO Executive Committee can authorize the launch of an update process. That process is identical with that of a de novo guideline except that it examines only a discrete set of recommendations directly related to the new evidence. Once the updated systematic review has been completed, the new or revised guideline recommendation(s) will be added to MAGICApp and published in conjunction in Kidney International. The update is also made available on the KDIGO website so that the currency of all guidelines can be assured when the reader searches www.MAGICApp.org or www.kdigo.org.
KDIGO also aims to continue to organize four or five Controversies Conferences each year. This signature program of KDIGO has brought together hundreds of globally recognized experts and kidney health practitioners to discuss and make observations on relevant aspects of kidney diseases that are not fully decided. Traditionally, these experts have been nephrologists, but more recently we have specifically sought input from a variety of other disciplines. Indeed, great contributions and valuable insights to the Conferences have been made by cardiologists, oncologists, intensivists, endocrinologists, emergency physicians, and other specialists who participate in the care of patients with kidney disease. The reports from our Controversies Conference are widely read online (Figure 3), downloaded, and cited, and our work is used around the world to help treat patients.
KDIGO also aims to build even more relevance to our constituents into our work by meaningfully involving patients. Our vision is to include patients at Controversies Conferences and even in Guideline Work Groups. We have established a Global Patient Network consisting of patients who told us that they want to volunteer as public reviewers, participate in focus groups, attend Controversies Conferences, and serve on Work Groups. They will be asked for input on all our activities. To further solidify this patient-centered approach, KDIGO will continue its relationship with the innovative Standardizing Outcomes in NephroloGy (SONG) initiative, which convenes focus groups for structured input on our work and helps us to better communicate with patients around the world. This effort is very important and builds commitment to our sole constituency: the patients.
We are also thinking creatively about ways to improve and enhance our guideline development process and knowledge translation. In this vein we have appointed a new Methods Committee to work with our esteemed Methods Chair and well-known evidence-base researcher, Marcello Tonelli, in strengthening and formalizing our guideline methodology. We are developing a Methods Manual to provide a formal source of benchmarks and reference support for future Work Groups, Evidence Review Teams, and the KDIGO organization as a whole.
We are also investing in our human resources. This year we added a new staff consultant, who worked for more than 14 years at the Tufts University and Brown University Evidence Review Centers, with which we had contracted in the past. We have continued the tradition of recruiting a high-quality and active Executive Committee to lead the organization. Its members are working on special projects to broaden their contributions to the organization. This group of 20 people, who meet twice a year, are among the best in the nephrology community. They work with hundreds of volunteers, past and present, to personally support and help advance KDIGO’s mission.
The 2019 Executive Committee is an excellent example of how KDIGO is building toward demographic and geographic representation. Our current leadership group has equal numbers of women and men and includes at least one member from every continent. We are also actively reaching out and inviting early-career academicians and non-academic real-world practitioners to participate in our activities. That kind of diversity will be reflected ever more prominently in future Controversies Conferences and Work Group rosters.
KDIGO’s future is very bright. We see an effective, efficient, and inclusive global organization spearheading and partnering in initiatives toward the goal for real improvement in the outcomes in patients with kidney disease worldwide. KDIGO has the resources, talent, and vision to be the vital part of global nephrology that is in keeping with the aspiration of our founders.