CKD-guideline adherence in primary and nephrology care for older patients with advanced CKD.

Cohort studyNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association· Aug 2026

CKD-guideline adherence in primary and nephrology care for older patients with advanced CKD.

Micha Jongejan, Janet M Kist, JHMarc Groeneveld … Marjolijn van Buren

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NephrologyCohort studyClinical practiceQ1IF 6.2

Most older patients with advanced chronic kidney disease are managed in primary care, not nephrology.

CKD-guideline adherence in primary and nephrology care for older patients with advanced CKD.

Micha Jongejan … Marjolijn van Buren

Nephrology, dialysis, transplantation · Aug 2026 · Q1 in General Medicine

Background

Older patients with chronic kidney disease (chronic kidney disease) often experience relatively slow kidney function decline, suggesting that, despite meeting referral criteria, primary care management may be appropriate.

Methods

Population-based study using routine healthcare data from primary care and hospitals, including patients ≥ 65 years with incident or prevalent eGFR <30 ml/min/1.73m2 between 2015 and 2024.

n = 1969 patients

Results

most were managed by primary care doctors, not kidney specialists

56.9%

Primary care

84.4%

Nephrology care

More results

In primary care, monitoring covered 82.5% of follow-up time for kidney function, 47.8% for albuminuria, 76.6% for blood pressure, 85.6% for haemoglobin, 50.9% for LDL-cholesterol and 68.3% for HbA1c among patients with diabetes.

Corresponding estimates in nephrology care were 86.8%, 65.2%, 84.4%, 97.5%, 68.3% and 84.9%, respectively.

More results

Monitoring of metabolic complications, which falls beyond primary care guidelines, was 28.4%-79.2% in primary care and 73.6%-97.8% in nephrology care.

RAAS inhibitors were prescribed in 56.9% (primary care) and 84.4% (nephrology care); SGLT2 inhibitors in 4.3% and 10.1%, and NSAIDs in both settings < 7%.

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Conclusion · 1 of 2

The majority of older patients with chronic kidney disease stage 4-5 are managed in primary care. Guideline adherence varied across care settings, which served substantially different patient populations.

Conclusion · 2 of 2

Higher adherence in patients with diabetes, typically enrolled in structured disease management programs, suggests that embedding similar structured approaches may enhance adherence to chronic kidney disease guideline in primary care.

CKD-guideline adherence in primary and nephrology care for older patients with advanced CKD.

CKD-guideline adherence in primary and nephrology care for older patients with advanced CKD.

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