Chronic kidney disease in Low- and Middle- Income Countries: Protocol for a systematic review of diagnostic and prognostic models

Abstract

Background: Chronic Kidney Disease (CKD) is a highly prevalent condition with a large disease burden globally. In low- and middle-income countries (LMIC) the CKD screening challenges the health system. This systematic and comprehensive search of all CKD diagnostic and prognostic models in LMIC will inform screening strategies in LMIC following a risk-based approach. Objective: To summarize all multivariate diagnostic and prognostic models for CKD in adults in LMIC. Methods: Systematic review. Without date or language restrictions we will search Embase, Medline, Global Health (these three through Ovid), SCOPUS and Web of Science. We seek multivariable diagnostic or prognostic models which included a random sample of the general population. We will screen titles and abstracts; we will then study the selected reports. Both phases will be done by two reviewers independently. Data extraction will be performed by two researchers independently using a pre-specified Excel form (CHARMS model). We will evaluate the risk of bias with the PROBAST tool. Conclusion: This systematic review will provide the most comprehensive list and critical appraisal of diagnostic and prognostic models for CKD available for the general population in LMIC. This evidence could inform policies and interventions to improve CKD screening in LMIC following a risk-based approach, maximizing limited resources and reaching populations with limited access to CKD screening tests. This systematic review will also reveal methodological limitations and research needs to improve CKD diagnostic and prognostic models in LMIC.

Systematic review of diagnostic and prognostic models of chronic kidney disease in low-income and middle-income countries

“…This systematic review and critical appraisal of the scientific literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines statement11 (online supplemental table S1). Protocol is available elsewhere12 and in online supplemental text S1. We followed the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS) guidelines 13 14…”

“…Cross-sectional (diagnostic models) and longitudinal studies (prognostic models) with a random sample of the general population were included. The outcome was CKD based on a laboratory or imaging test (isolated or in combination with self-reported diagnosis): urine albumin-creatinine ratio, urine protein-creatinine ratio, albumin excretion ratio, urine sediment, kidney images, kidney biopsy or the estimated glomerular filtration rate (eGFR) 12…”

“…A qualitative synthesis was conducted whereby the characteristics of the selected models was comprehensively described 12. Quantitative analysis (meta-analysis) was not conducted because the selected models used different predictors and they had different outcome definitions.…”

“…Protocol is available elsewhere 12 and in online supplemental text S1. We followed the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS) guidelines.…”

“…The outcome was CKD based on a laboratory or imaging test (isolated or in combination with self-reported diagnosis): urine albumin-creatinine ratio, urine protein-creatinine ratio, albumin excretion ratio, urine sediment, kidney images, kidney biopsy or the estimated glomerular filtration rate (eGFR). 12 Reports had to present the development and/or validation of a multivariable model. On the other hand, reports with LMIC populations outside LMIC, or those including foreigners living in LMIC, were excluded.…”