REDEFINING THE GLOBAL LANDSCAPE OF KIDNEY GENETICS CARE: SCOPING REVIEW, INTERNATIONAL STAKEHOLDER CONSULTATION, AND THEORY-GROUNDED SYNTHESIS OF A GLOBAL IMPLEMENTATION ROADMAP

Successful implementation of kidney genetics services is critical to improve patient, service, and implementation outcomes. Yet, implementation-focused evidence in this space remains limited. In this Part 2 companion analysis, we synthesize determinants—barriers and facilitators, and align them to tailored strategies for implementation, integrating a global scoping review and international survey.

We conducted a scoping review (JBI methodology, PRISMA-ScR compliant; OSF registered) of English-language publications (2000–2025) reporting determinants of kidney genetics implementation. 2 reviewers coded and quantified determinants using the Consolidated Framework for Implementation Research (CFIR) across 5 domains: innovation, individuals, inner setting, outer setting, and process. Top-ranked barriers were matched to strategies using the Expert Recommendations for Implementing Change (ERIC) tool. In parallel, a 42-item survey of international clinic leads captured real-world determinants and strategies. Findings were synthesized across both review and survey data.

Of 60 studies; 28 reported determinants (4 explicit, 24 implicit): North America (NA) 16, Australia/New Zealand (ANZ) 4, United Kingdom (UK)/Ireland 3, and Europe (EU) 5.

Barriers: NA: individual (18) and outer setting (29) predominated, notably limited implementation team capability/motivation (13), low care recipients capability/motivation (5), financing constraints (14), and insurer pre-authorization requirement (9). ANZ: individual (15) and inner setting (15) predominated with lack of available resources (4), culture (3), infrastructure (3), limited access to knowledge (2), weak relational connections (2), and financing gap (1). Reporting from UK/EU was limited: innovation (7) with service complexity (5) reported most often. Domain-stratified barriers across regions are shown in Fig 1-2.

51 survey responses corroborated the review patterns (Fig 3).

Top barriers in descending orders: implementation team capability (22), financing (16), innovation complexity (14), policies/laws (10), available resources (9), and team motivation (8).

Facilitators: Across regions, innovation (33) and inner setting (30) predominated. Within innovation, relative advantage (12), design quality (12), adaptability (7), and evidence-base (2) supported implementation. Within inner setting, strong relational connections (14), available resources (8), access to knowledge/information (3), and genetics-centered culture (2) enabled implementation.

Domain-stratified facilitators are shown in Fig 4-5; survey responses mirrored the review findings (Fig 6).

Strategies: Top matched strategies using ERIC tool in descending orders: train/educate stakeholders, change liability laws, secure funding 162%, alter incentive structure 100%, fund clinical innovation 88%, identify and prepare champions 87%, involve executive boards 82%, develop a formal implementation blueprint 78% (Fig 7). Strategies proposed by global leads mimicked ERIC-derived priorities (Fig 8).

Barriers vary by region, while facilitators converge on innovation and inner setting domains. Our CFIR-ERIC synthesis yields a prioritized strategy bundle ready for pragmatic hybrid trials to improve outcomes. Under-representation of Asia, Africa, and South America is a critical equity gap requiring targeted research and policy partnerships.