Kidney Week

Abstract: TH-PO1007

Assessing the Quality of Care for People with CKD: A Systematic Review and Meta-Analysis

Session Information

• CKD: Epidemiology, Risk Factors, and Prevention - 1
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Ketema, Daniel Bekele, The George Institute for Global Health, Sydney, New South Wales, Australia

Daniel Bekele Ketema, MPH

• Wallace, Hannah, The George Institute for Global Health, Sydney, New South Wales, Australia

Hannah Wallace, MBBS

• Neuen, Brendon Lange, The George Institute for Global Health, Sydney, New South Wales, Australia

Brendon Lange Neuen, MBBS, MS, PhD, FASN

• Kotwal, Sradha S., The George Institute for Global Health, Sydney, New South Wales, Australia

Sradha S. Kotwal, MBChB, PhD

• Ronksley, Paul E., University of Calgary Department of Community Health Sciences, Calgary, Alberta, Canada

Paul E. Ronksley, PhD

• Badve, Sunil, The George Institute for Global Health, Sydney, New South Wales, Australia

Sunil Badve, MD, MBBS, PhD, FASN

• Perkovic, Vlado, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia

Vlado Perkovic, MBBS, PhD, FASN

• Gallagher, Martin P., The George Institute for Global Health, Sydney, New South Wales, Australia

Martin P. Gallagher, MBBS, PhD, MPH

• Joshi, Rohina, University of New South Wales Medicine & Health, Sydney, New South Wales, Australia

Rohina Joshi

• Jun, Min, The George Institute for Global Health, Sydney, New South Wales, Australia

Min Jun, PhD

Background

Effective strategies for managing CKD are available, but the extent to which implementation of these strategies is consistent with guideline recommendations is uncertain. We aimed to synthesize available data on the quality of CKD care globally.

Methods

EMBASE, PubMed, and CINAHL were systematically searched (inception–2023) for observational studies reporting on the quality of CKD care across domains related to patient monitoring (eGFR, albuminuria), appropriate medication use (ACEIs, ARBs, statins, NSAIDs), and treatment targets (BP, HbA1c) according to management recommendations in international CKD guidelines. Pooled estimates (95% CI) of the percentage of patients who met the quality indicators for CKD care were obtained using random effects meta-analysis.

Results

58 studies across 22 countries, including a total of 2,969,039 patients with CKD, were included. The reporting of and adherence to quality indicators for CKD care varied substantially across the included studies (Figure 1). Summary estimates of the percentage of CKD patients who met key indicators showed that (1) eGFR was monitored in 81% (75–87%) of patients, albuminuria in 47% (40–54%) and BP in 90% (84–95%); (2) ACEIs/ARBs were prescribed in 56% (51–62%), statins in 56% (48–64%), and NSAIDs withheld in 81% (77–86%) and (3) a BP target of ≤140/90 mmHg was achieved in 56% (48–64%) patients.

Conclusion

Current evidence suggests substantial variation in the reporting and quality of CKD care. Concordance with guideline recommendations varied across quality indicators and patient groups, with opportunities for considerable improvement, particularly albuminuria testing. Effective quality improvement strategies to address gaps in CKD care, along with systematic approaches for monitoring care quality, are needed.

Figure 1: Forest plot summarising the percentage of patients with CKD who met the quality indicators for CKD care