Abstract
Background: In high-income countries, chronic kidney disease (CKD) affects over 10% of the population. Identifying these patients early on is a priority, especially as new treatments are available to reduce the risk of cardiovascular and renal morbidity. We aimed to understand the management and care pathway of patients with early-to-moderate CKD defined by an estimated glomerular filtration rate (eGFR) ≥ 45 mL/min/1.73m 2 (CKD-EPI), by analyzing the experience of general practitioners (GPs) in a region in France.Methods: This qualitative semiopragmatic phenomenological study analyzed in-depth interviews held with a purposive sample (age, gender, training, type of practice, rural/urban context) of 24 GPs, with triangulation of research until data saturation.Results: From diagnostic, etiological and prognostic viewpoints, the GPs in our study perceived CKD as a complex, poorly-defined clinical entity in asymptomatic and multimorbid patients. They distinguished it from a rare condition they considered as 'mainly renal'. The fact that they did not perceive early-stage CKD as a disease was a hindrance to patient care, which aims to protect the kidneys in a preventive approach. Indeed, GPs perceived CKD patient management as a care pathway requiring a personalized, multidisciplinary integrative model, common to all chronic diseases, without necessarily involving a nephrologist.Conclusions: This study demonstrates how the GPs' representations influence their attitudes and interventions. Clarifying the concept of early-stage CKD by taking factors like age and etiology into account would facilitate personalized management of this heterogenous, often multimorbid, population. Finally, organizational models to support patient empowerment in an integrative care pathway must be validated.