Evidence map›Paper›PMID 40908011›Full record

SynthesisBMJ open2025

Quality of care for people with chronic kidney disease: a systematic review and meta-analysis.

Daniel Bekele Ketema, Hannah Wallace, Workagegnehu Hailu, Sunil V Badve, Paul Ronksley, Brendon L Neuen, Roberto Pecoits-Filho, Martin Gallagher, Sradha Kotwal, Vlado Perkovic and 2 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Daniel Bekele KetemaRenal and Metabolic Program, The George Institute for Global Health, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0002-7464-7814
Hannah WallaceRenal and Metabolic Program, The George Institute for Global Health, Sydney, New South Wales, Australia.
Workagegnehu HailuDepartment of Internal Medicine, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia.
Sunil V BadveRenal and Metabolic Program, The George Institute for Global Health, Sydney, New South Wales, Australia.
Paul RonksleyCommunity Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
Brendon L NeuenRenal and Metabolic Program, The George Institute for Global Health, Sydney, New South Wales, Australia.
Roberto Pecoits-FilhoSchool of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil.
Martin GallagherRenal and Metabolic Program, The George Institute for Global Health, Sydney, New South Wales, Australia.
Sradha KotwalRenal and Metabolic Program, The George Institute for Global Health, Sydney, New South Wales, Australia.
Vlado PerkovicRenal and Metabolic Program, The George Institute for Global Health, Sydney, New South Wales, Australia.
Rohina JoshiSchool of Population Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia.
Min JunRenal and Metabolic Program, The George Institute for Global Health, Sydney, New South Wales, Australia mjun@georgeinstitute.org.au.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesGuideline-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.

designSystematic 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.

results59 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%).

conclusionsCurrent 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.

Indexed as

Quality of Health CareRenal Insufficiency, ChronicAlbuminuriaAngiotensin Receptor AntagonistsGlomerular Filtration RateHumansPractice Guidelines as TopicQuality Indicators, Health CareAngiotensin Receptor AntagonistsChronic kidney diseaseMeta-AnalysisQuality ImprovementSystematic Review

Identifiers

PMID40908011
PMCPMC12414227

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.