GLOBAL SCIENCELOCAL CHANGE

Kidney Disease: Improving Global Outcomes

2019 KDIGO LEADERSHIP

Michel Jadoul, Belgium Wolfgang Winkelmayer, USA

Mustafa Arici, Turkey

Tara Chang, USA

John Davis, CEO, USA

John Gill, Canada

Morgan Grams, USA

Fan Fan Hou, China

Kunitoshi Iseki, Japan

Magdalena Madero, Mexico

Jolanta Malyszko, Poland

Ikechi Okpechi, South Africa

Rukshana Shroff, UK

Laura Sola, Uruguay

Paul Stevens, Secretary-Treasurer, UK

Marcello Tonelli, Canada

Suzanne Watnick, USA

Angela Webster, Australia

David Wheeler, UK

Christina Wyatt, USA

Executive Committee:

KDIGO Co-Chairs:

KDIGO STAFF

John Davis, NY Chief Executive OfficerDanielle Green, CA Executive DirectorMichael Cheung, NY Chief Scientific Officer Melissa Thompson, IL Chief Operating OfficerAmy Earley, MA Guideline Development DirectorTanya Green, LA Communications Director

Official Corporate Location: Brussels, Belgium

THE KDIGO MISSION

Improving the care and outcomes of kidney disease patients worldwide through the

development and implementation of global clinical practice guidelines.

Clinical Practice Guidelines in Nephrology began in 1995• Under the umbrella of DOQI/KDOQI by the US National Kidney Foundation (NKF)• Produced guidelines through 2002

Concept of Global Clinical Practice Guidelines explored in 2003 & 2004• Concept included forming a new global organization• KDIGO was launched in 2004• Incorporated in Belgium as a non-profit foundation• Continued to be managed by NKF under a service contract

KDIGO grew through 2012 when it became independent• KDIGO became self governed and self financed• Led by active volunteers and a small staff• Over 1,000 clinicians and scientists have participated

KDIGO is funded by many sources, is transparent and financially stable• No funding directly from industry for guidelines or updates• Funding is sought for general support, conferences, and implementation activities

KDIGO HISTORY

• Translate scientific advances into useful and practical clinical practice recommendations and observations.

• Maintain and enhance its brand representing trusted and usable global scientific information.

• Make the global science available and understandable to clinicians around the world.

• Implement its work through local and regional programs taking into account cultural, economic, language, regulatory and environmental issues.

• Adapt, simplify, prioritize and validate recommendations and observations for clinician use in everyday practice.

KDIGO AIMS TO

KDIGO’S PROGRAM AGENDA• Clinical Practice Guidelines

• KDIGO’s core mission = Development, vetting, dissemination, and implementation of Guidelines

• Guideline Updates• Evidence-based, not time-based, streamlined process makes quicker updates possible

• Controversies Conferences• Conferences that examine significant topics in nephrology and related disciplines that are not fully

resolved. Over 40 so far. Each results in a published Conference Report, usually in Kidney International. Often a Controversies Conference will prompt development of a guideline.

• Implementation Summits• Gathers KOL’s from a country or region to discuss barriers and opportunities for implementation of

KDIGO recommendations

• Clinical Practice Conferences• Usually held through invitations from local nephrology societies

• Educational Tools• Variety of formats, languages, electronic or print, resource driven

KDIGO Clinical Practice Guidelines

• Keeping up with new science is difficult for busy clinicians who cannot read all the journals, monitor all the congress presentations and know the latest studies

• Clinicians cannot be expected to judge study quality

• Physicians and patients need practical, easily accessible recommendations to aid decisions

• Disclosing gaps in evidence can stimulate research

• KDIGO is a global leader in translational kidney science

• KDIGO is not a society, accountable to members; it is accountable only to patients

REASONS FOR GLOBAL GUIDELINES

• Based on a systematic review of existing evidence• Based on the best and latest information available• Designed to provide information and assist decision-making• Developed by a knowledgeable, multidisciplinary panel of global experts and

representatives from key stakeholders• A forum for patient involvement as appropriate• Based on an explicit, scientifically rigorous and transparent process that minimizes

distortions, biases, and conflicts of interest• Reflective of ratings of both the quality of evidence and the strength of the

recommendations • Are reconsidered and revised as appropriate whenever important new evidence

warrants modifications of recommendation

KDIGO GUIDELINES ARE…

Institute of Medicine. Clinical Practice Guidelines We Can Trust. 2011. http://www.iom.edu/Reports/2011/Clinical-Practice-Guidelines-We-Can-Trust.aspx

• Intended to define a standard of care

• To be interpreted as prescribing an exclusive course of management

• Specific practice protocols

• Intended to be regulatory in nature

Healthcare professionals making use of KDIGO guidelines are responsible for making their own informed practice decisions using help from KDIGO and its

global science analyses

KDIGO GUIDELINES ARE NOT…

• KDIGO has a Methods Committee continually updating and modernizing its scientific processes and rigor

• Decisions on Guideline topics and timetables are made by the Executive Committee based on scientific need, the availability of evidence, and resources

• Guideline updates follow a similar process and are becoming more frequent through modular design and electronic publishing

• Additional topics will be added by the Executive Committee for new guidelines and the timing of updates

• Goal of a KDIGO library of 20-25 “living” guidelines covering all topics in nephrology, constantly updated to ensure they are current

KDIGO GUIDELINE PROCESS

• Science is global

• Variations in practice inevitably and appropriately occur

• Implementation takes into account the needs of individual patients, available resources, costs, and limitations unique to a country, region, institution or a type of practice

• KDIGO partners with nephrology societies, governments, hospitals, etc. to adapt guidelines to local circumstances

• Global guidelines are valuable for physicians, industry partners, and societies when engaging with ministries of health, regulatory agencies, and insurance bodies

KDIGO GUIDELINE - LOCAL ADAPTATION

Lipid Management November 2013CKD-MBD Update July 2017

Living Kidney Donors August 2017Hepatitis C Update October 2018

KDIGO GUIDELINES

Hepatitis C April 2008Mineral Bone Disorder July 2009Transplant Recipient Oct 2009

Acute Kidney Injury March 2012

Glomerulonephritis June 2012Anemia August 2012

Blood Pressure in CKD November 2012Diagnosis and Management of CKD January 2013

UPCOMING KDIGO GUIDELINES

Transplant Candidate Evaluation – Steve Chadban, Australia & Greg Knoll, CanadaPublication date: Q3/Q4 2019

Glomerulonephritis Update – Jurgen Floege, Germany & Brad Rovin, USAPublication date: Q3/Q4 2020

Blood Pressure in CKD Update – Alfred Cheung, USA & Johannes Mann, GermanyPublication date: Q3/Q4 2020

Diabetes in CKD – Ian DeBoer, USA & Peter Rossing, DenmarkPublication date: Q1/Q2 2021

KDIGO GUIDELINES – MOST CITED IN KI SUPPLEMENTS

KDIGO Guidelines are the TOP FIVE MOST CITED ARTICLES in Kidney International Supplements

KDIGO ControversiesConferences

KDIGO CONTROVERSIES CONFERENCES2018:

• Dialysis Initiation, Modality Choice & Prescription• Coronary Artery & Valvular Diseases in CKD• Potassium Management• Onco-Nephrology

2017:• HIV Related Kidney Diseases• Heart Failure in CKD• Blood Pressure in CKD• Glomerular Diseases

2016:• Common Elements in Uncommon Kidney Diseases• Challenges in the Conduct of Clinical Trials• CKD & Arrhythmias• Optimal Management of Patients with Advanced CKD

2015:• Diabetes & CKD• Fabry Disease• Complement-Mediated Kidney Diseases• Gitelman Syndrome

2014:• ADPKD• Iron Management in CKD• ADTKD• Nephropathic Cystinosis

2013:• CKD-MBD: Back to the Future• Supportive Care

2004-12:• Diabetic Kidney Disease• Novel Techniques & Innovation in Blood Purification• Cardiovascular Disease in CKD• Drug Prescribing in CKD: Initiative for Improved Dosing• Definition, Classification, and Prognosis in CKD • Blood Pressure in CKD - Stage 5D• Methodology and Transparency• Coordination of Guidelines for Anemia in CKD• Care of the Transplant Recipient• Definition, Evaluation & Classification of Renal

Osteodystrophy• Definition & Classification of CKD in Adults Worldwide

The KDIGO conference report on “The definition, classification and prognosis of CKD” is the MOST CITED ARTICLE in Kidney International (658 times)

The 2017 KDIGO conference report on “Screening, diagnosis, and management of patients with Fabry disease” is the FOURTH MOST READ ARTICLE in Kidney International

KDIGO CONFERENCE REPORTS - MOST CITED & MOST READ IN KI

KDIGO CONTROVERSIES CONFERENCE SCHEDULE2019

Blood Pressure Management in Dialysis • Lisbon, Portugal | February 7-10, 2019

Acute Kidney Injury• Rome, Italy | April 25-27, 2019

Nomenclature• Amsterdam, the Netherlands | June 27-29

Early Intervention & Identification of CKD• Mexico City, Mexico | October 3-6, 2019

Optimal Anemia Management (Iron)• Barcelona, Spain | December 12-15, 2019

2020

Coronary & Peripheral Artery Disease• Dublin, Ireland | February 20 – 23, 2020

Home Dialysis• Location TBD | April 2020

Acute Kidney Disease• Location TBD | June, 2020

Genetic Kidney Disease• Location TBD | Date TBD

Novel Therapies in Anemia (HIFs)• Location TBD | December 2020

KDIGO ImplementationActivities

• Publication of KDIGO Guidelines and Conference Report are the first step to changing clinical practice

• In countries all over the world, KDIGO teaches about its Guidelines and Conference Reports at Clinical Practice Conferences and in presentations at local and regional Nephrology Congresses

KDIGO IMPLEMENTATION

2018 CLINICAL PRACTICE CONFERENCES

• Cartagena, Colombia - April 18-21 - Presentations on Dialysis Modality Choice, CKD-MBD and HIV Nephropathy

• Seoul, Korea - May 15 - Presentations on Hepatitis C, Glomerular Diseases, Heart Failure in CKD• Mexico City, Mexico - June 20-22 - Presentation on Arrhythmias & CKD, and Heart Failure in CKD• Shanghai, China - July 20-22 - Presentations on Dialysis Initiation and Modality Choice• Xian, China - Sept 13-15 - Presentations on Glomerular Diseases, CKD-MBD, Cardio-Renal Issues &

Anemia• Vladivostok, Russia - Sept 14 - 15 - Presentation on Blood Pressure• Rio, Brazil - Sept 19 - 22 - Presentations on Diabetes, Glomerular Diseases and Cardio-Renal Issues• Guiyang, China - Sept 20 - 22 - Presentations on Anemia and Hepatitis C• Mombasa, Kenya - Sept 26 - 29 - Presentation on HIV Nephropathy• Moscow, Russia - Oct 18-20 - Presentations on Glomerular Diseases and Complement Disorders

KDIGO WEBSITE• Top 5 Countries for Traffic:

• United States

• Mexico

• Canada

• Brazil

• United Kingdom

• Social Media Reach:

• 9,445 Facebook Friends

• 7,855 Twitter Followers

• 623 Instagram Followers

KDIGO CLINICAL PRACTICE GUIDELINE APP – DOWNLOAD TODAY!

THANK YOU!KDIGO WOULD LIKE TO THANK THE FOLLOWING PARTNERS FOR THEIR

UNRESTRICTED EDUCATIONAL GRANTS

ASTRAZENECA, BOEHRINGER INGELHEIM AND LILLY ALLIANCE, FRESENIUS MEDICAL CARE