Self-reported Financial Conflict of Interest in Nephrology Clinical Practice Guidelines

Abstract

Introduction There is ongoing controversy concerning the potential influence of industry and financial conflict of interest (FCOI) in the development of clinical practice guidelines (CPG). The influence of industry in renal guideline development has been discussed in the past with emphasis on the National Kidney foundation (NKF) and Kidney and Dialysis Outcomes Quality Initiative guidelines. In this study we evaluate the self-reported FCOI among guideline panel members in Kidney Disease: Improving Global Outcomes (KDIGO) CPGs. Methods We examined 10 of the most recent KDIGO CPGs developed between 2009 and 2018. Using disclosure lists, we catalogued FCOIs for panelists for each individual CPG. The categories were Advisor/Consultant, Honoraria, Travel Stipend, Grant/Research Support, Speaker, Equity Interest, Employee, Board of Trustees, Royalties, Advisory Board, Employment, Ownership, Data Monitoring Committee, Expert Testimony, and Development of Education Materials. We also reviewed FCOIs for members of evidence review team (ERT). We also catalogued the company involved in each disclosure. One conflict describes 1 instance of participation of an individual in 1 category in each guideline. “Company” describes a commercial, industry, or institute affiliation reported in each episode. Results One hundred two (66.4%) of the total 151 panelists reported FCOI. A total of 662 conflicts were disclosed. Being a consultant or advisor was the most common category. One hundred fifty-one companies were associated with FCOI disclosure. One company was most frequently reported, involving 60 (9%) of 662 conflicts. Of the 52 members in the ERT, there was 1 instance of FCOI. Conclusion FCOI is prevalent in KDIGO guidelines with almost two thirds of the panelists self-reporting FCOI. The evidence review team had only 1 instance of FCOI.

Evaluation of Conflicts of Interest among Participants of the Japanese Nephrology Clinical Practice Guideline

“…The prevalence of Japanese guideline authors with payments ranged from 78% for oncology guidelines (37) to 95% for hematology guidelines (14), and the average annual payments ranged from $10,565 for the oncology guidelines (37) to $28,371 for infectious disease guidelines (38). However, Japanese authors of CKD guidelines may have had more financial COIs compared with those in other countries, as 66% of KDIGO guideline authors self-reported financial COIs with pharmaceutical companies (17).…”

“…Jefferson and Pearson (31) found that US cholesterol management guidelines and US hepatitis C guidelines deviated from the US National Academy of Medicine standards, and this deviation remained (49). Also, Chengappa et al (17) reported that 90% of KDIGO guidelines had more than half of the guideline authors with reported COIs, which is one of the deviations from the US National Academy of Medicine. All medical societies and organizations developing guidelines should pay more attention to financial COIs with pharmaceutical companies during guideline development and broader nonfinancial COIs.…”

“…In the field of nephrology, Coyne (16) pointed out that pharmaceutical companies, particularly those marketing and manufacturing drugs for anemia and CKD, were involved in the development of the National Kidney Foundation’s guideline for anemia in patients with CKD, which potentially led to overuse of drugs due to marketing their drugs. In another case, one recent study by Chengappa et al (17) found that almost two thirds of the Kidney Disease Improving Global Outcomes (KDIGO) guideline authors had financial COIs with pharmaceutical companies. Therefore, appropriate and rigorous strategies for the management of COIs and guideline development are especially required in nephrology.…”

Evaluation of Financial Conflicts of Interest and Quality of Evidence Underlying the American Diabetes Association Clinical Practice Guidelines: The Standards of Medical Care in Diabetes, 2021

“…Only one author failed to self-report FCOI. Many previous studies showed that there were widespread financial conflicts of interest between guideline authors and the healthcare industry in most specialties [13,16,17,19,[27][28][29][30][31][32][33][34][35][36][37]. Most of these studies reported that the majority of the guideline authors received payments from the healthcare industry [3,[38][39][40][41][42][43] and there were large amounts of undisclosed FCOIs with the healthcare industry [13,16,17,34,38,44].…”

Implementation strategies for high impact nephrology trials: the end of the trial is just the beginning

“…While there are complexities around the influence of industry partners on guideline development, a link between industry payments and favourable nephrology guideline recommendations was reported and discussed extensively following the 2006 update of the KDOQI anaemia guidelines (Supplementary References S8). Recently, major departures by J o u r n a l P r e -p r o o f 8 KDIGO from the national standards for managing financial conflicts of interests (FCOI), alongside the (not necessarily related) conclusion that many KDIGO guidelines are predicated on the weak evidence of expert opinion, has renewed interest in the relationship between industry partners and guideline producers 9 . Clearly, this issue is not unique to nephrology clinical practice guidelines, however adherence to a minimum set of standards for managing FCOI, enforced by journal editors, may enhance synthesis of RCT evidence into guideline recommendations.…”