title: Understanding kidney care needs and implementation strategies in low- and middle-income countries: conclusions from a "Kidney Disease: Improving Global Outcomes" (KDIGO) Controversies Conference.
abstract: 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.
authors.affiliation: George Institute for Global Health, New Delhi, India; University of Oxford, Oxford, UK. Electronic address: vjha@pginephro.org.
authors.forename: Vivekanand
authors.initials: V
authors.lastname: Jha
authors.affiliation: Department of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Arici
authors.affiliation: Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota, USA; Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Collins
authors.affiliation: Nephrology Service, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Centre, Hospital 278, Guadalajara, Jalisco, Mexico.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Garcia-Garcia
authors.affiliation: Department of Community Health Sciences, Libin Cardiovascular Institute, Institute of Public Health, and Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Hemmelgarn
authors.affiliation: Program in Health Services & Systems Research, Duke-NUS Graduate Medical School, Singapore; Department of Community Health Science, Aga Khan University, Karachi, Pakistan; Section of Nephrology, Department of Medicine, Aga Khan University, Karachi, Pakistan.
authors.forename: Tazeen H
authors.initials: TH
authors.lastname: Jafar
authors.affiliation: School of Medicine, Pontificia Universidade Católica do Paraná, Curitiba, Brazil.
authors.forename: Roberto
authors.initials: R
authors.lastname: Pecoits-Filho
authors.affiliation: Comité de Salud Renal del Ministerio de Salud Publica de Uruguay, Montevideo, Uruguay.
authors.forename: Laura
authors.initials: L
authors.lastname: Sola
authors.affiliation: Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, South Africa.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Swanepoel
authors.affiliation: Nephrology Development Clinical Center, Tbilisi State Medical University, Tbilisi, Georgia.
authors.forename: Irma
authors.initials: I
authors.lastname: Tchokhonelidze
authors.affiliation: Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong.
authors.forename: Angela Yee Moon
authors.initials: AY
authors.lastname: Wang
authors.affiliation: Division of Nephrology, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
authors.forename: Bertram L
authors.initials: BL
authors.lastname: Kasiske
authors.affiliation: University College London, London, UK.
authors.forename: David C
authors.initials: DC
authors.lastname: Wheeler
authors.affiliation: University of Skopje, Medical Faculty, University Department of Nephrology, Skopje, Macedonia. Electronic address: spasovski.goce@gmail.com.
authors.forename: Goce
authors.initials: G
authors.lastname: Spasovski
mesh_terms: D017281:Cost of Illness; D003695:Delivery of Health Care; D003906:Developing Countries; D006291:Health Policy; D006801:Humans; D007674:Kidney Diseases; D017410:Practice Guidelines as Topic; D000078329:Workforce
keywords: acute kidney injury; advocacy; chronic kidney disease; clinical practice guidelines; implementation; low and middle income countries