Nephrol Dial Transplant (2016) 31: ii1–ii66 doi: 10.1093/ndt/gfw356 Clinical Practice Guideline Clinical Practice Guideline on management of older patients with chronic kidney disease stage 3b or higher (eGFR <45 mL/min/1.73 m 2 ) Ken Farrington, Adrian Covic, Fillipo Aucella, Naomi Clyne, Leen de Vos, Andrew Findlay, Denis Fouque, Tomasz Grodzicki, Osasuyi Iyasere, Kitty J. Jager, Hanneke Joosten, Juan Florencio Macias, Andrew Mooney, Dorothea Nitsch, Marijke Stryckers, Maarten Taal, James Tattersall, Dieneke Van Asselt, Nele Van den Noortgate, Ionut Nistor and Wim Van Biesen for the ERBP guideline development group 1. ABBREVIATIONS AND ACRONYMS AKI Acute kidney injury CKD Chronic kidney disease CKD-EPI Chronic Kidney Disease Epidemiology Collaboration CM Conservative management eGFR Estimated glomerular filtration rate ERA-EDTA European Renal Association – European Dialysis and Transplant Association ERBP European Renal Best Practice ESKD End-stage kidney disease HD Hemodialysis HR Hazard ratio KFRE Kidney Failure Risk Equation MD Mean Difference MDRD Modification of Diet in Renal Disease OR Odds Ratio PD Peritoneal dialysis QoL Quality of life RCT Randomized controlled trial REIN Renal Epidemiology and Information Network RR Relative Risk RRT Renal replacement therapy SGA Subjective global assessment 95% CI 95% Confidence Interval 2. FOREWORD The mean age of the general population is increasing, resulting in a higher prevalence of older patients. The health manage- ment of this specific subpopulation poses serious questions, which are not limited to clinical issues, but also involve ethical and social issues. Despite the growing number of frail and older patients with eGFR <45 mL/min/1.73 m 2 , most studies still exclude this population, so providing guidance on the management of these patients with CKD stage 3b or higher (eGFR <45 mL/ min/1.73 m 2 ) remains problematic. There is a paucity of well- designed, prospective studies in this population. This limits the evidence base for these approaches. The advisory board of ERBP decided during its meeting in Is- tanbul 2013 that a guideline on the management of older patients with CKD stage 3b or higher (eGFR <45 mL/min/1.73 m 2 ) was needed and timely. There was a clear need to support patients, their families and the healthcare professionals with evidence-based guidance on how to approach this specific population. There was recognition of the importance of evidence-based approaches to pa- tient care to enhance quality, improve safety and establish a clear and transparent framework for service development and health- care provision within an ethical and societal perspective. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focussed on patient-centered outcomes and had utility for clinicians in- volved in everyday practice. We hope you enjoy reading this guideline and that you will find it useful in your everyday management of older patients with CKD stage 3b or higher. Most of all, we hope that this guide- line will contribute to improved outcomes for these patients. The guideline development group. 3. COMPOSITION OF THE GUIDELINE DEVELOPMENT GROUP After approval of the project concept by the ERBP advisory board, a working group convened in May 2013 and decided on © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved ii1 Downloaded from https://academic.oup.com/ndt/article/31/suppl_2/ii1/2414986 by guest on 09 June 2022