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.
Bibliographical noteFunding 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.
The conference was sponsored by KDIGO and supported in part by unrestricted educational grants from Fresenius Medical Care, Roche, Sandoz Biopharmaceuticals, and Sanofi.
© 2016 International Society of Nephrology
- acute kidney injury
- chronic kidney disease
- clinical practice guidelines
- low and middle income countries