guideline

Vitamin D regulates bone homeostasis,1 and epidemiologic studies suggest that lower vitamin D levels may be associated with increased risk of RTIs, cardiovascular disease, malignancy, and metabolic disorders.2,3 Increased awareness of possible health benefits associated with higher 25(OH)D levels has resulted in widespread vitamin D testing and supplementation in the general US population. Nonetheless, there is no consensus on a threshold value below which people should be offered vitamin D supplementation.3,4 In 2021, the US Preventive Services Task Force reported that there was insufficient evidence to recommend routine screening of asymptomatic adults for vitamin D deficiency.4 Rates of marked vitamin D deficiency (25[OH]D ≤12 ng/mL) vary by race and ethnicity, with higher rates in non-Hispanic Asian (8%), non-Hispanic Black (18%), and Hispanic (6%) people compared with non-Hispanic White people (2%).3

Author/s:

Eva S Liu, Andrew M Davis, Sherri-Ann M Burnett-Bowie

Non-Surgical Interventions for Lumbar Spinal Stenosis Leading To Neurogenic Claudication: A Clinical Practice Guideline

Saige Blanchard — Wed, 30 Jun 2021 05:00:00 +0000

Date Added:

June 30, 2021

Journal/Publication:

Journal of Pain

Publisher:

Elsevier

Publication Date:

December 12, 2020

Issue:

Pages:

1526-5900

URL:

Non-Surgical Interventions for Lumbar Spinal Stenosis Leading To Neurogenic Claudication: A Clinical Practice Guideline

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.jpain.2021.03.147

Keywords

Lumbar Spinal Stenosis

Neurogenic Claudication

Clinical

symptoms

guideline

PMID (1):

33857615

MeSH

Calcitonin

gabapentin

analgesics, opioid

antidepressive agents, tricyclic

Spinal Stenosis

Spondylolisthesis

These three recommendations regarding nonsurgical treatment of lumbar spinal stenosis from a Canadian guideline panel seem reasonable. James W. Mold, MD, MPH

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Lumbar spinal stenosis (LSS) causing neurogenic claudication (NC) is increasingly common with an aging population and can be associated with significant symptoms and functional limitations. We developed this guideline to present the evidence and provide clinical recommendations on nonsurgical management of patients with LSS causing NC. Using the GRADE approach, a multidisciplinary guidelines panel based recommendations on evidence from a systematic review of randomized controlled trials and systematic reviews published through June 2019, or expert consensus. The literature monitored up to October 2020. Clinical outcomes evaluated included pain, disability, quality of life, and walking capacity. The target audience for this guideline includes all clinicians, and the target patient population includes adults with LSS (congenital and/or acquired, lateral recess or central canal, with or without low back pain, with or without spondylolisthesis) causing NC. The guidelines panel developed 6 recommendations based on randomized controlled trials and 5 others based on professional consensus, summarized in 3 overarching recommendations: (Grade: statements are all conditional/weak recommendations) Recommendation 1. For patients with LSS causing NC, clinicians and patients may initially select multimodal care nonpharmacological therapies with education, advice and lifestyle changes, behavioral change techniques in conjunction with home exercise, manual therapy, and/or rehabilitation (moderate-quality evidence), traditional acupuncture on a trial basis (very low-quality evidence), and postoperative rehabilitation (supervised program of exercises and/or educational materials encouraging activity) with cognitive-behavioral therapy 12 weeks postsurgery (low-quality evidence). Recommendation 2. In patients LSS causing NC, clinicians and patients may consider a trial of serotonin-norepinephrine reuptake inhibitors or tricyclic antidepressants. (very low-quality evidence). Recommendation 3. For patients LSS causing NC, we recommend against the use of the following pharmacological therapies: nonsteroidal anti-inflammatory drugs, methylcobalamin, calcitonin, paracetamol, opioids, muscle relaxants, pregabalin (consensus-based), gabapentin (very low-quality), and epidural steroidal injections (high-quality evidence). PERSPECTIVE: This guideline, on the basis of a systematic review of the evidence on the nonsurgical management of lumbar spine stenosis, provides recommendations developed by a multidisciplinary expert panel. Safe and effective non-surgical management of lumbar spine stenosis should be on the basis of a plan of care tailored to the individual and the type of treatment involved, and multimodal care is recommended in most situations.

Author/s:

Bussieres, A., Cancelliere, C., Ammendolia, C., Comer, C. M., Zoubi, F. A., Chatillon, C. E., Chernish, G., Cox, J. M., Gliedt, J. A., Haskett, D., Jensen, R. K., Marchand, A. A., Tomkins-Lane, C., O'Shaughnessy, J., Passmore, S., Schneider, M. J., Shipka, P., Stewart, G., Stuber, K., Yee, A., Ornelas, J.

Management of Blood Pressure in Patients With Chronic Kidney Disease Not Receiving Dialysis: Synopsis of the 2021 KDIGO Clinical Practice Guideline

Saige Blanchard — Wed, 23 Jun 2021 05:00:00 +0000

Date Added:

June 23, 2021

Journal/Publication:

Annals of Internal Medicine

Publisher:

American College of Physicians

Publication Date:

June 22, 2021

URL:

Management of Blood Pressure in Patients With Chronic Kidney Disease Not Receiving Dialysis: Synopsis of the 2021 KDIGO Clinical Practice Guideline

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7326/M21-0834

Keywords

PMID (1):

34152826

MeSH

blood pressure

renal dialysis

Renal Replacement Therapy

referral and consultation

risk assessment

renal insufficiency, chronic

Eleven guideline recommendations for management of elevated BP in patients with CKD from the Kidney Disease: Improving Global Outcomes (KDIGO). James W. Mold, MD, MPH

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Description: The Kidney Disease: Improving Global Outcomes (KDIGO) 2021 clinical practice guideline for the management of blood pressure (BP) in patients with chronic kidney disease (CKD) not receiving dialysis is an update of the KDIGO 2012 guideline on the same topic and reflects new evidence on the risks and benefits of BP-lowering therapy among patients with CKD. It is intended to support shared decision making by health care professionals working with patients with CKD worldwide. This article is a synopsis of the full guideline.

Methods: The KDIGO leadership commissioned 2 co-chairs to convene an international Work Group of researchers and clinicians. After a Controversies Conference in September 2017, the Work Group defined the scope of the evidence review, which was undertaken by an evidence review team between October 2017 and April 2020. Evidence reviews were done according to the Cochrane Handbook. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to guide the development of the recommendations and rate the strength and quality of the evidence. Practice points were included to provide guidance when evidence was insufficient to make a graded recommendation. The guideline was revised after public consultation between January and March 2020.

Recommendations: The updated guideline comprises 11 recommendations and 20 practice points. This synopsis summarizes key recommendations pertinent to the diagnosis and management of high BP in adults with CKD, excluding those receiving kidney replacement therapy. In particular, the synopsis focuses on recommendations for standardized BP measurement and a target systolic BP of less than 120 mm Hg, because these recommendations differ from some other guidelines.

Author/s:

Tomson, C. R. V., Cheung, A. K., Mann, J. F. E., Chang, T. I., Cushman, W. C., Furth, S. L., Hou, F. F., Knoll, G. A., Muntner, P., Pecoits-Filho, R., Tobe, S. W., Lytvyn, L, Craig, J. C., Tunnicliffe, D. J., Howell, M., Tonelli, M., Cheung, M., Earley, A., Ix, J. H., Sarnak, M. J.