Clinical practice guideline for renal hypouricemia (1st edition)

Renal hypouricemia (RHUC) is a disease caused by dysfunction of renal urate reabsorption transporters; however, diagnostic guidance and guidelines for RHUC have been lacking, partly due to the low evidence level of studies on RHUC. This review describes a world-first clinical practice guideline (CPG) and its first version in English for this condition. It was developed following the "MINDS Manual for Guideline Development" methodology, which prioritizes evidence-based medicine. It was published in Japanese in 2017 and later translated into English. The primary goal of this CPG is to clarify the criteria for diagnosing RHUC; another aim is to work towards a consensus on clinical decision-making. One of the CPG's unique points is that it contains textbook descriptions at the expert consensus level, in addition to two clinical questions and recommendations derived from a systematic review of the literature. The guidance shown in this CPG makes it easy to diagnose RHUC from simple blood and urine tests. This CPG contains almost all of the clinical foci of RHUC: epidemiology, pathophysiology, diagnostic guidance, clinical examinations, differential diagnosis, and complications, including exercise-induced acute kidney injury and urolithiasis. A CPG summary as well as a clinical algorithm to assist healthcare providers with a quick reference and notes from an athlete for both physicians and patients are included. We hope that this CPG will help healthcare providers and patients to make clinical decisions, and that it will promote further research on RHUC.

A new scale for the evaluation of clinical practice guidelines applicability: development and appraisal

Background

This study aimed to develop the clinical practice guidelines applicability evaluation (CPGAE-V1.0) scale and to evaluate its validity and reliability.

Methods

One hundred fifty assessors were invited to rate two rounds of importance scoring of the applicability indicators by using the 5-point Likert scale. Approved indicators formed the CPGAE-V1.0 scale, consisting of 19 items, arranged into 4 domains. We enrolled eligible clinicians from 8 institutions to evaluate 9 clinical practice guidelines using the CPGAE-V1.0 scale. Content validity, construct validity, internal reliability, intra-rater reliability, and responsiveness were analyzed.

Results

A total of 220 clinicians participated, and the response rate was 98.6% (217/220). The CPGAE-V1.0 scale had favorable content validity. The four-factor model produced acceptable fit indices. The scale had an excellent internal consistency and item discrimination. It could identify the degree of applicability of the different dimensions between different guidelines. In all domains, 77.8% (7/9) of CPGs in the minimum-scoring domain were concentrated in the “coordination of support” domain.

Conclusions

The CPGAE-V1.0 scale is a valid and reliable instrument for measuring the applicability of CPG.

Electronic supplementary material

The online version of this article (10.1186/s13012-018-0746-5) contains supplementary material, which is available to authorized users.