VARIABILITY IN REGIONAL AND NATIONAL FRAMEWORKS FOR THE MANAGEMENT OF CHRONIC KIDNEY DISEASE IN THE PRIMARY CARE SETTING

Chronic kidney disease (CKD) is increasingly recognized as a noncommunicable disease of public health importance, with reduced access to optimal care in low- and middle-income countries (LMICs). Given the large number of people affected, the locus of care must shift from specialists to primary care, and this requires effective policy plan across countries. Information on availability of policy frameworks and/or guidelines for CKD management in the primary care setting is limited. 

A rigorous, scoping review was conducted to identify and compare existing care models for CKD across world regions. A comprehensive search was undertaken in Ovid MEDLINE, Ovid Embase, CINAHL, Scopus, and Web of Science Core from 2010 to July 11, 2025. A separate search was also conducted on Overton using the search term “chronic kidney disease” to retrieve policy documents and grey literature not commonly found in conventional databases. Our inclusion criteria included guideline and policy documents that highlighted (1) models of care, (2) workforce, (3) infrastructure, (4) diagnostics, (5) health information systems, and (6) quality of care relating to managing CKD in the primary care setting. 

A total of 2623 unique results were for the initial title and abstract screening. Additionally, our search on Overton yielded 431 results. After screening using the inclusion criteria, a total of 23 documents were identified. Various regional documents highlighted specific referral criteria, including highlighting which patients were deemed not likely to derive significant benefit from specialist referral for reasons of age, limited life expectancy, and multi-morbidity. For example, in Malaysia, the decision to refer elderly patients to nephrology mandated assessment whether kidney replacement therapy would be pursued or not. Guidelines from the Canary Islands provided considerations for when not to refer to nephrology with advanced age (>80 years of age), significant comorbidity and appropriateness of dialysis initiation. Prevention programs emphasized early detection among those with traditional risk factors such as cardiometabolic disease, while guidelines from Central America emphasized screening strategies in agricultural regions with a higher risk for developing CKD of non-traditional origin (CKD-NT). For example, in El-Savador, the ministry of public health had proposed a surveillance system for screening patients over the age of 20 years and highlighted specific profiles of those with CKD-NT (young, living in hot climate, specific occupations and exposures, etc).

This scoping review showed variations in guidelines and policy frameworks for CKD management in the primary care across world regions. There were common themes that surfaced including the need for (1) explicit criteria on categories of patients that would benefit from specialist care to reduce strain on the local workforce and (2) scaling up screening beyond traditional cardiometabolic risk factors to also include geographic factors to identify hot spots for endemic CKD. This work has implications on the development, implementation and evaluation of an international framework to guide CKD management in primary care.