{
  "abstract": "Objectives Guideline-based strategies to prevent chronic kidney disease (CKD) progression and complications are available, yet their implementation in clinical practice is uncertain. We aimed to synthesise the available evidence on the concordance of CKD care with clinical guidelines to identify gaps and inform future CKD care.Design Systematic review and meta-analysis.Data sources, participants, and outcomes We systematically searched MEDLINE (OVID), EMBASE (OVID) and CINAHL (EBSCOhost) (to 18 July 2025) for observational studies of adults with CKD reporting data on the quality of CKD care. We assessed data on quality indicators of CKD care across domains that related to patient monitoring (glomerular filtration rate and albuminuria), medications use (ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), statins) and treatment targets (blood pressure (BP) and HbA1c). Pooled estimates (95% CI) of the percentage of patients who met the quality indicators for CKD care were estimated using random effects model.Results 59 studies across 24 countries, including a total of 3 003 641 patients with CKD, were included. Across studies, 81.3% (95% CI: 75% to 87.6%) of patients received eGFR monitoring, 47.4% (95% CI: 40.0% to 54.7%) had albuminuria testing, and 90% (95% CI: 84.3% to 95.9%) had BP measured. ACEIs/ARBs were prescribed among 56.7% (95% CI: 51.5% to 62%), and statins among 56.6% (95% CI: 48.9% to 64.3%) of patients. BP (systolic BP ≤140/90 mm Hg) and HbA1c (<7%) targets were achieved in 56.5% (95% CI: 48.5% to 64.6%) and 43.5% (95% CI: 39.4% to 47.6%) of patients, respectively. Subgroup analysis indicated higher rates of proteinuria testing among patients with diabetes (52.2%) compared with those without (31.3%).Conclusions Current evidence shows substantial variation in CKD care quality globally. Guideline-concordant care varied according to quality measures and across patient groups, with gaps in indicators like albuminuria testing. These findings underscore the need for effective quality improvement strategies to address gaps in CKD care, including increased albuminuria testing for risk stratification, together with systematic measures for monitoring care quality.PROSPERO registration number CRD42023391749.",
  "authors": [
    {
      "affiliations": [
        "Renal and Metabolic Program, The George Institute for Global Health, Sydney, New South Wales, Australia",
        "Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia",
        "School of Public Health, College of Medicine and Health Science, Debre Markos University College of Health Science, Debre Markos, Ethiopia"
      ],
      "name": "Daniel Bekele Ketema"
    },
    {
      "affiliations": [
        "Renal and Metabolic Program, The George Institute for Global Health, Sydney, New South Wales, Australia",
        "Western Health Chronic Disease Alliance, Western Health, Footscray, VIC, Australia",
        "Faculty of Medicine and Health, University of Melbourne, Melbourne, VIC, Australia"
      ],
      "name": "Hannah Wallace"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia"
      ],
      "name": "Workagegnehu Hailu"
    },
    {
      "affiliations": [
        "Renal and Metabolic Program, The George Institute for Global Health, Sydney, New South Wales, Australia",
        "Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia",
        "Department of Renal Medicine, St. George Hospital, Sydney, New South Wales, Australia"
      ],
      "name": "Sunil V Badve"
    },
    {
      "affiliations": [
        "Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada"
      ],
      "name": "Paul Ronksley"
    },
    {
      "affiliations": [
        "Renal and Metabolic Program, The George Institute for Global Health, Sydney, New South Wales, Australia",
        "Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia",
        "Faculty of Medicine & Health, University of Sydney, Sydney, New South Wales, Australia",
        "Department of Renal Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia"
      ],
      "name": "Brendon L Neuen"
    },
    {
      "affiliations": [
        "School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil",
        "ClinEpi Program, Arbor Research Collaborative for Health, Ann Arbor, MI, USA"
      ],
      "name": "Roberto Pecoits-Filho"
    },
    {
      "affiliations": [
        "Renal and Metabolic Program, The George Institute for Global Health, Sydney, New South Wales, Australia",
        "Liverpool Clinical School, UNSW Sydney, Sydney, New South Wales, Australia"
      ],
      "name": "Martin Gallagher"
    },
    {
      "affiliations": [
        "Renal and Metabolic Program, The George Institute for Global Health, Sydney, New South Wales, Australia",
        "Prince of Wales Hospital NCCC, Randwick, New South Wales, Australia"
      ],
      "name": "Sradha Kotwal"
    },
    {
      "affiliations": [
        "Renal and Metabolic Program, The George Institute for Global Health, Sydney, New South Wales, Australia",
        "Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia"
      ],
      "name": "Vlado Perkovic"
    },
    {
      "affiliations": [
        "School of Population Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia",
        "The George Institute for Global Health, New Delhi, India"
      ],
      "name": "Rohina Joshi"
    },
    {
      "affiliations": [
        "Renal and Metabolic Program, The George Institute for Global Health, Sydney, New South Wales, Australia",
        "Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia"
      ],
      "name": "Min Jun"
    }
  ],
  "title": "Quality of care for people with chronic kidney disease: a systematic review and meta-analysis",
  "uid": "ff60d295-1f41-5a19-bf73-895267630a19"
}