Abstract
Introduction: It is essential to identify patients with chronic kidney disease (CKD) early on to limit cardiovascular and renal complications, especially as new treatments are available. Despite the international recommendations, the management of these patients seems suboptimal. We wanted to understand how these patients with early-to-moderate CKD were actually managed, by all those involved, in order to identify possible means of improvement.Method: We made a systematic review of studies focusing on the management of ambulatory adult patients with CKD in high-income countries, whose estimated glomerular filtration rate was 45 ml/min/1.73m2 or over. Publications in English between 2000 and 2022 were identified from the MEDLINE, Embase, Cochrane, Knowledge Translation and PDQ-Evidence databases using search equations and MeSH terms. For each inclusion a double assessment of biases was made, and examining the references led to the inclusion of new articles. PRISMA guidelines were followed (PROSPERO 314490). Results: Ninety full texts were included in this comprehensive review. In primary care, management of early-to-moderate CKD patients remains suboptimal due to lack of knowledge, non-guideline-compliant management, and insufficient coordination between general practitioners and nephrologists. These shortcomings lead to limited screening, inadequate follow-up, and low patient involvement in their own care. Several areas for improvement emerged: developing tools to help clinical decision-making and coordination, promoting multi-professional management including nurses and nephrologists, and reinforcing patient education. Multimodal approaches, combining training and technological and human support would improve patient management. Conclusion: This summary illustrates differences between the guidelines and actual practices.