IDENTIFYING MULTISTAKEHOLDER PRIORITIES FOR SYSTEMATIC REVIEWS AND CLINICAL PRACTICE GUIDELINES IN CHRONIC KIDNEY DISEASE: A DELPHI SURVEY

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Abstract Title *

IDENTIFYING MULTISTAKEHOLDER PRIORITIES FOR SYSTEMATIC REVIEWS AND CLINICAL PRACTICE GUIDELINES IN CHRONIC KIDNEY DISEASE: A DELPHI SURVEY

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Co-author 1

Brydee Cashmore brydee.cashmore@sydney.edu.au The University of Sydney Sydney School of Public Health Sydney Australia -

Co-author 2

Martin Howell martin.howell@sydney.edu.au The University of Sydney Leeder Centre for Health Economics Sydney Australia -

Co-author 3

Chananda Guha chandana.guha@sydney.edu.au The University of Sydney Sydney School of Public Health Sydney Australia -

Co-author 4

Allison Jauré allison.jaure@sydney.edu.au The University of Sydney Sydney School of Public Health Sydney Australia -

Co-author 5

Rathika Krishnasamy rathika.krishnasamy@health.qld.gov.au Sunshine Coast University Hospital Department of Nephrology Birtinya Australia -

Co-author 6

Vincent Lee vincent.lee@health.nsw.gov.au Centre for Kidney Research Westmead Hospital Sydney Australia -

Co-author 7

Nicole Scholes-Robertson nicole.scholes-robertson@sydney.edu.au The University of Sydney Sydney School of Public Health Sydney Australia -

Co-author 8

Amanda Sluiter amanda.sluiter@sydney.edu.au The University of Sydney Sydney School of Public Health Sydney Australia -

Co-author 9

Jonathan Craig jonathan.craig@flinders.edu.au Flinders University College of Medicine and Health Adelaide Australia -

Co-author 10

David Tunnicliffe david.tunnicliffe@sydney.edu.au Centre for Kidney Research The Children's Hospital at Westmead Sydney Australia *

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Topic selection for evidence-based guidance, including systematic reviews and clinical guidelines, often lacks meaningful community engagement. This study aims to identify the shared priorities between people with lived experience of CKD and health professionals, to ensure that evidence-based care addresses what matters most, supporting shared decision-making and improved outcomes.

Methods

A three-round modified Delphi survey was conducted across the four chronic kidney disease (CKD) treatment stages: non-dialysis CKD, peritoneal dialysis (PD), haemodialysis (HD), and transplantation. In Round 1, consumers and health professionals rated (Likert scales) and ranked (Best-Worst Scaling) broad topics. High-priority topics were further refined into subtopics and rated in Round 2. In Round 3, high-priority subtopics were re-rated and ranked. Progression through the survey was based on Likert scores, agreement, and BWS rankings, and agreement. Quantitative data was analysed (mean ± SD, % agreement – rated 7-9), using descriptive statistics and multinomial logistic regression.

Results

Participation increased from 106 in Round 1 (27% consumers) to 613 in Round 3 (71% consumers). The highest rated and ranked topics in Round 1 were ‘Evaluation and management of CKD’ (8.09±1.11, 93%), ‘Management of infection and peritonitis in PD’ (7.98±1.41, 88%), ‘Cardiovascular disease management in HD’ (7.96±1.33, 89%), and ‘Transplant rejection’ (8.36±1.05, 96%). Across Rounds 2 and 3, the highest rated and ranked subtopics included were: ‘Treatment to slow CKD progression’ (6.37±2.53, 56%), ‘Maintenance of residual kidney function in PD (7.19±2.10, 96%)’, ‘Volume control in HD’ (7.15±2.12, 75%)., and ‘Management of medication side-effects in transplant’ (6.65±2.53, 65%). Consumers consistently rated lifestyle and psychosocial topics higher than health professionals.

Conclusion

This stakeholder-driven prioritisation identified a focus on slowing CKD progression of CKD and improving symptoms during kidney replacement therapy to guide future systematic reviews and guidelines. Addressing these priorities may strengthen the relevance of the evidence base for shared decision-making in CKD.

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