What should a guideline panel do when evidence is inconclusive? the case of treatments for CKDmineral and bone disorder (CKD-MBD)

摘要

Chronic kidney disease-mineral and bone disorder (CKD-MBD) is unique to patients with CKD. Recent attention to this disorder has been fueled by observations of a high prevalence of abnormalities associated with disordered mineral metabolism and associations of these abnormalities with vascular manifestations, including calcification, clinical cardiovascular disease, and increased mortality in patients with CKD. Despite widespread adoption of treatments for MBD in clinical practice, high-quality trials with hard clinical outcomes are lacking. Given the paucity of randomized controlled trials, guideline groups often are faced with the challenge of having to weigh observational evidence.