Policy strategies to enhance uptake of conservative kidney management in advanced chronic kidney disease: a systematic review and meta-analysis

Abstract

Background: Conservative kidney management (CKM) is an established treatment option for patients with advanced chronic kidney disease(CKD) who are not candidates for kidney replacement therapy(KRT). Despite its benefits, CKM uptake remains low. This systematic review aims to evaluate the effectiveness of policy strategies designed to promote CKM uptake in advanced CKD patients. Methods: Relevant studies were identified through searches of Medline, Scopus, and CINAHL databases since 2000 through 24 July 2024. Observational studies or randomized controlled trials that assessed the efficacy of interventions aiming to increase CKM utilization or preference in patients with chronic kidney disease were eligible for this study. Pairwise meta-analysis using the inverse variance or DerSimonion and Laird method, was applied to estimate the efficacy of interventions across studies. Results: Seven studies were included in this systematic review. Education and training interventions which provided knowledge about CKM to patients and their families, did not significantly increased preference for CKM among CKD patients, compared to no intervention with a pooled OR of 1.05 (95% CI: 0.62–1.76; I² = 0%). In contrast, results of two included studies found that strategies focused on reforming healthcare services, particularly through assessing patient prognosis and communicating results to nephrologists to inform decisions on KRT, significantly increased CKM utilization in patients with advanced CKD. Conclusion: Our findings suggest that educating patients and their families about CKM did not result in a statistically significant increase in CKM preference compared to no intervention. In contrast, interventions aimed at reforming healthcare services by implementing prognostication assessments into clinical practice might significantly increase CKM utilization. However, these conclusions are based on a limited number of observational studies, highlighting the need for further research to validate the effectiveness of these interventions.