Advancing Clinical Care through ASN Kidney Health Guidance

To inform clinical decisions, nephrologists and other kidney health professionals rely on scholarly, peer-reviewed literature to augment established knowledge, skills, experience, and patient preferences. Most medical specialty societies produce a range of clinical guidelines and other clinical guidance, including practice points and consensus guidance. These are developed in accordance with standardized principles, such as those recommended by the National Academy of Medicine, formerly the Institute of Medicine, to encourage the practice of evidence-based medicine.¹ A growing range of guidance types has now facilitated the rapid development of briefer, targeted guidance documents, in turn enabling timelier translation of best available evidence to support clinical decision making.

The American Society of Nephrology (ASN) routinely assesses gaps in knowledge and care as well as opportunities to better meet the needs of people with kidney diseases and their clinicians (particularly nephrologists), the society's members, and the broader kidney community. Medical specialty societies are responsible for serving as the preeminent source of evidence-based clinical practice guidance and the tools and resources required for guidance implementation. ASN is unique among medical specialty societies in that it has not produced clinical practice guidelines. However, in 2022, the ASN Council approved a change in policy resulting in the allocation of resources to build ASN's capacity to develop and disseminate clinical guidance.

ASN Kidney Health Guidance will encourage high-quality, person-directed care across the spectrum of kidney health and diseases spanning the kidney care journey from screening and early detection to diagnosis, treatment, and palliative care. ASN is using person-directed care intentionally. Person-directed care aligns outcomes and treatment goals to ensure importance to persons with kidney diseases and being respectful of values and preferences.² ASN acknowledges that other organizations produce rigorous and expert nephrology clinical guidance. In evaluating the need for ASN to enter the clinical guidance space, the ASN Council identified opportunities to produce guidance that is both innovative and agile. ASN's approach will help address concerns that current nephrology guidelines take years to produce. Especially during the current period of rapidly expanding diagnostic and therapeutic options, timely guidance can serve the needs of patients and providers alike. ASN will align its efforts with member needs and broader community efforts to improve care in nephrology. Moreover, ASN can maximize reach through the society's communication channels, including three peer-reviewed journals. ASN Kidney Health Guidance will focus predominantly on implementation, in part to meet the broadly identified need to inform and improve federal policy and payment structure in the kidney space.

As the leading association representing nephrology health professionals, ASN is well positioned to work with other medical specialty societies, health care systems, and diverse stakeholders to produce clinical guidance for the care of people with kidney diseases. ASN's effort will emphasize producing kidney health guidance that is succinct, focused on clinical practice and health system topics, and addressing emerging, urgent, or high-priority issues. This focus will facilitate moving into the guidance space with innovation, nimbleness, and flexibility, complementing and enhancing existing offerings in kidney care.

ASN does not intend to duplicate existing clinical practice guidelines or introduce contradictory information that would convey uncertainty in clinical approaches. Rather, by identifying existing or emerging topics that fill gaps in knowledge for the kidney community, ASN Kidney Health Guidance will bolster the clinical armamentarium available to nephrologists and other health professionals. Consistent with other societies, ASN also recognizes the increasing need to produce practice-relevant information and guidance in easily usable, readable, searchable, and electronically accessible formats. To succeed, ASN Kidney Health Guidance development must follow a rigorous, yet sustainable, iterative process which will allow the society to respond to needs for expert, evidence-based information to guide patient care (Figure 1).

Figure 1.

ASN Kidney Health Guidance (AKHG). ASN, American Society of Nephrology.

To safeguard the integrity of the ASN Kidney Health Guidance process, an oversight committee will ensure that the society is developing guidance free from identified conflicts of interest (COI) and commitment. Potential conflicts must be appropriately disclosed in accordance with ASN's policies governing COI and commitment. ASN will review declared COI and determine whether these conflicts are manageable for a topical workgroup and, if so, how they should be addressed. On the basis of disclosures, proposed workgroup members will be considered as free from relevant COI, having manageable COI, or having disqualifying COI that must be terminated before serving as a voting member of the guideline panel. Experts with uniquely valuable insight into the subject matter who have disqualifying COI may be permitted to participate as nonvoting expert contributors.

ASN will focus on guidance topics that are important for the interdisciplinary kidney care team and their patients, and topics will be prioritized when they address unmet clinical need(s) and areas of clinical ambiguity. As disparities in care and outcomes are critically important to address across kidney health, one major focus will be on health equity. Beyond patient care, ASN anticipates that a broadened understanding of current patient care practices will help identify areas for future research. Notably, ASN's separate foundation, KidneyCure, is the largest private funder of kidney research.

In addition to identifying promising topics, the oversight committee will select the guidance development workgroup co-chairs. These co-chairs must be without COI that could be perceived to bias the evaluation of evidence, leadership of the workgroup, or the content of the guidance. Membership in these workgroups will be multidisciplinary to reflect a variety of perspectives. The inclusion of perspectives from people with kidney diseases and their caregivers or family members will be particularly essential to drive kidney health guidance toward patient centeredness.

Guidance development workgroups will follow a consensus development process designed to foster input and discussion from clinical experts, patients, and other kidney care team members. Because initial topic areas will focus on emerging clinical challenges that typically have a dearth of high-quality evidence, expert opinion and best available evidence will serve as the foundation for workgroup consensus deliberations.

Obesity and Kidney Diseases will be ASN's first topic for clinical guidance. The development workgroup is co-chaired by T. Alp Ikizler, MD, FASN, and Holly J. Kramer, MD, MPH. Dr. Ikizler and Dr. Kramer will be joined by a multidisciplinary workgroup with expertise in nephrology, endocrinology, obesity medicine, bariatric surgery, transplant, nutrition and physical activity, health equity, and psychology. ASN will publish this initial kidney health guidance in the society's journals, such as the JASN, starting later in 2024.

Through this new initiative, ASN is positioned to leverage existing relationships, build new partnerships, and broaden the network of stakeholders in kidney health. By producing and disseminating evidence-based guidance, ASN will promote person-directed care and an outcomes-oriented care trajectory for people with kidney diseases. Beyond kidney health guidance, ASN intends to create dynamic education tools and resources and assertively communicate information about kidney medicine to serve as a foundation for health care quality initiatives (through ASN Excellence in Patient Care), educational initiatives (ideally, ASN Kidney Week), publications, and legislative and regulatory policy advocacy—aligning with ASN's vision of a world without kidney diseases.

Disclosures

D.C. Crews reports consultancy for Yale New Haven Health Services Corporation Center for Outcomes Research and Evaluation (CORE); research funding from Baxter International and Somatus, Inc.; role on the Editorial Boards for CJASN, JASN, and Journal of Renal Nutrition; role as an Associate Editor for Kidney360; advisory or leadership role for Advisory Group, Health Equity Collaborative, Optum Labs, and Partner Research for Equitable System Transformation after COVID-19 (PRESTAC); and other interests or relationships with American Board of Internal Medicine Nephrology Board, American College of Physicians Council of Subspecialist Societies, as American Society of Nephrology Executive Councilor, and National Kidney Foundation of Maryland/Delaware Board of Directors. S.L. Sampsel reports consultancy for American Academy of Physical Medicine and Rehabilitation, American Society of Nephrology, National Committee for Quality Assurance, Novo Nordisk, and Vertex; advisory or leadership role for National Kidney Foundation Colorado/New Mexico; and other interests or relationships with American Society of Nephrology.

Funding

None.

Author Contributions

Visualization: Deidra C. Crews.

Writing – original draft: Deidra C. Crews, Sarah L. Sampsel.

Writing – review & editing: Deidra C. Crews, Sarah L. Sampsel.