Understanding kidney care needs and implementation strategies in low- and middle-income countries: conclusions from a “Kidney Disease: Improving Global Outcomes” (KDIGO) Controversies Conference

Vivekanand Jha, Mustafa Arici, Allan J. Collins, Guillermo Garcia-Garcia, Brenda R. Hemmelgarn, Tazeen H. Jafar, Roberto Pecoits-Filho, Laura Sola, Charles R. Swanepoel, Irma Tchokhonelidze, Angela Yee Moon Wang, Bertram L. Kasiske, David C. Wheeler, Goce Spasovski, Lawrence Agodoa, Ghazali Ahmad, Vathsala Anantharaman, Fatiu Arogundade, Gloria Ashuntantang, Sudarshan BallalEbun Bamgboye, Chatri Banchuin, Boris Bogov, Sakarn Bunnag, Worawon Chailimpamontri, Ratana Chawanasuntorapoj, Rolando Claure-Del Granado, Somchai Eiam-Ong, Lynn Gomez, Rafael Gómez, Dimitrios Goumenos, Hai An Ha Phan, Valentine Imonje, Atiporn Ingsathit, Faiçal Jarraya, Sirin Jiwakanon, Surasak Kantachuvesiri, Umesh Khanna, Vijay Kher, Kamol Kitositrangsikun, Zhi Hong Liu, Pichet Lorvinitnun, Nazaire Nseka, Gregorio T. Obrador, Ikechi Okpechi, Duangta Onsuwan, Vuddhidej Ophascharoensuk, Charlotte Osafo, David Peiris, Warangkana Pichaiwong, Kearkiat Praditpornsilpa, Mohan Rajapurkar, Ivan Rychlik, Gamal Saadi, Vicente Sanchez Polo, Pornpen Sangthawan, Nirut Suwan, Vladimir Tesar, Prapaipim Thirakhupt, Thananda Trakarnvanich, Yusuke Tsukamoto, Kriang Tungsanga, Supat Vanichakarn, Evgueniy Vazelov, Christoph Wanner, Anthony Were, Elena Zakharova

Research output: Contribution to journalArticlepeer-review

54 Scopus citations


Evidence-based cinical practice guidelines improve delivery of uniform care to patients with and at risk of developing kidney disease, thereby reducing disease burden and improving outcomes. These guidelines are not well-integrated into care delivery systems in most low- and middle-income countries (LMICs). The KDIGO Controversies Conference on Implementation Strategies in LMIC reviewed the current state of knowledge in order to define a road map to improve the implementation of guideline-based kidney care in LMICs. An international group of multidisciplinary experts in nephrology, epidemiology, health economics, implementation science, health systems, policy, and research identified key issues related to guideline implementation. The issues examined included the current kidney disease burden in the context of health systems in LMIC, arguments for developing policies to implement guideline-based care, innovations to improve kidney care, and the process of guideline adaptation to suit local needs. This executive summary serves as a resource to guide future work, including a pathway for adapting existing guidelines in different geographical regions.

Original languageEnglish (US)
Pages (from-to)1164-1174
Number of pages11
JournalKidney international
Issue number6
StatePublished - Dec 1 2016

Bibliographical note

Funding Information:
VJ declared having received research support from Baxter and GlaxoSmithKline. AJC declared having received consultancy fees from AstraZeneca, Bayer, Gilead, and Relypsa. GG-G declared having received consultancy fees from Pisa Farmaceutica and speaker honoraria from Abbvie. THJ declared having received research support from Wellcome Trust UK, Medical Research Council, Department for International Development, and Singapore Ministry of Health. RP-F declared having received consultancy fees from Akebia and Janssen; speaker honoraria from AstraZeneca, Janssen, and Novartis; and research support from Fresenius. CRS declared having received consultancy fees from Fresenius. AYMW declared having received speaker honoraria from Sanofi. DCW declared having received consultancy fees from Akebia, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, GlaxoSmithKline, Janssen, Otsuka, UCB Celltech, and Vifor; speaker honoraria from Amgen, Fresenius, Janssen, Vifor, and ZS Pharma; and research support from British Heart Foundation, Healthcare Quality Improvement Partnership, Kidney Research UK, National Institute for Health Research, and Australian National Health & Medical Research Council. All the other authors declared no competing interests.

Funding Information:
The conference was sponsored by KDIGO and supported in part by unrestricted educational grants from Fresenius Medical Care, Roche, Sandoz Biopharmaceuticals, and Sanofi.

Publisher Copyright:
© 2016 International Society of Nephrology


  • acute kidney injury
  • advocacy
  • chronic kidney disease
  • clinical practice guidelines
  • implementation
  • low and middle income countries


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