PURPOSE: To identify and prioritize potential topics to be addressed in the development of European multidisciplinary guidelines on the management of chronic kidney disease stage 3b-5 in older patients. METHODS: We composed a list of 47 potential guideline topics by reviewing the literature, consulting online 461 nephrologists and 107 geriatricians, and obtaining expert input. A multidisciplinary panel of twelve experts then prioritized the topics during a face-to-face consensus meeting, following a nominal group technique structure with two voting rounds. Topics were rated on a 9-point scale ranging from 1 ('not at all important') to 9 ('critically important'). RESULTS: The highest rating (median; range) was assigned to 'Screening and referral' (8.5; 2.0). Eight topics shared the second highest rating with a median priority score of 8.0 (2.0) and included 'Starting dialysis or not' and 'Accurate assessment of renal function.' 'Targets for and treatment of diabetes' received the lowest rating with (3.0; 6.0). CONCLUSIONS: This joint initiative of the European Renal Association-European Dialysis Transplant Association (ERA-EDTA) and the European Union Geriatric Medicine Society (EUGMS) prioritized the development of guidance on interdisciplinary referral of older patients with chronic kidney disease stage 3b-5. Future guidance will therefore focus on identifying prognostic scores to predict death and progression to end-stage renal disease, as well as accurate tests for assessment of renal function in older kidney patients. This will contribute to more informed treatment decision making in this growing patient population.

CNR Institute of Clinical Physiology Reggio Calabria Italy

Department of Geriatric Medicine 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Geriatric Medicine Ghent University Hospital Ghent Belgium

Department of Internal Medicine University Center of Geriatric Medicine University Medical Center Groningen Groningen The Netherlands

Division of Nephrology Department of Internal Medicine Medical University of Graz Graz Austria

Division of Nephrology Department of Internal Medicine University Hospital Maastricht Maastricht The Netherlands

ERA EDTA Registry Department of Medical Informatics Academic Medical Center Amsterdam The Netherlands

European Renal Best Practice Methods Support Team Ghent University Hospital Ghent Belgium

Faculty of Medicine University of Salamanca Salamanca Spain

Health eResearch Centre Farr Institute for Health Informatics Research University of Manchester Vaughan House Portsmouth Street Manchester M13 9GB UK

Imperial College Renal and Transplant Centre Hammersmith Hospital London UK

Nephrology Department AZ Maria Middelares Hospital Ghent Belgium

Nephrology Department Gr T Popa University of Medicine and Pharmacy Iasi Romania

Renal Division Ghent University Hospital Ghent Belgium

Renal Unit Lister Hospital Stevenage Hertfordshire UK

Renal Unit St James's University Hospital Leeds Teaching Hospitals NHS Trust Leeds UK

University of Geneva Geneva Switzerland

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