Children are addressed in Chapters 16 (diagnosis) and 17 (treatment), and elderly patients are addressed separately in Chapter 20. Renal replacement therapy is covered in Chapters 18 (dialysis) and 19 (renal transplantation), but the discussion is centered on problems encountered when non-dialysis CKD patients are switched to renal replacement therapy. These Guidelines are focused on non-dialysis CKD
patients and exclude, in principle, dialysis and renal transplant patients. 4. Evidence levels and recommendation grades Evidence was classified into six levels based on the study design, and was arranged roughly from the most reliable study type (Level 1) to the least reliable (Level Selleckchem Entospletinib 6). These levels do not necessarily represent rigorous scientific standards; they
are APR-246 concentration intended for use as a convenient reference for quickly assessing the significance of various clinical data during the physician’s decision-making process. Evidence levels Level 1: Systematic review/meta-analysis. Level 2: At least one randomized controlled trial (RCT). Level 3: A non-randomized controlled trial. Level 4: An analytical epidemiologic study (cohort study or case–control study) or a single-arm intervention study (no controls). Level 5: A descriptive study (case report or case series). Level 6: Opinion of an expert committee or https://www.selleckchem.com/products/byl719.html an individual expert, which is not based on patient data. However, for a systematic review/meta-analysis, the evidence level was decided based on the designs of the underlying studies. If the underlying study designs were mixed, the lowest level underlying study was why used to determine the overall evidence level. For example, a meta-analysis of cohort studies would be Level 4, but the same Level 4 would also be assigned to a meta-analysis including both RCTs and cohort studies. In addition, a decision based on committee consensus was that all sub-analyses and post hoc analyses of RCTs should be categorized at evidence Level 4. Accordingly, it was decided that the evidence level of
findings representing the primary endpoints of an RCT would be Level 2, but the evidence level of findings determined via a sub-analysis or post hoc analysis of that RCT would be Level 4. When a statement related to a certain treatment was presented, consideration was given to the level of the evidence serving as the basis of that statement, and a recommendation grade was assigned as outlined below: Recommendation grades Grade A: Strongly recommended because the scientific basis is strong. Grade B: Recommended because there is some scientific basis. Grade C1: Recommended despite having only a weak scientific basis. Grade C2: Not recommended because there is only a weak scientific basis. Grade D: Not recommended because scientific evidence shows the treatment to be ineffective or harmful.
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