Challenges in the clinical use of digital tools in healthcare: barriers and blueprint for Kidney Failure Risk Equation implementation (Preprint)

BACKGROUND Chronic kidney disease (CKD) affects approximately 10% of the global population and is a major contributor to morbidity and the need for kidney replacement therapy. The Kidney Failure Risk Equation (KFRE) is a validated risk prediction tool, yet its implementation remains limited. OBJECTIVE To identify barriers to KFRE implementation and propose a blueprint for integrating digital risk tools into healthcare systems. METHODS Narrative synthesis of barriers across domains (data infrastructure, clinician engagement, technology integration, and policy), informed by UK NHS case study experience. RESULTS Key barriers include low rates of urine albumin-creatinine ratio testing, assay and formula variability for eGFR, limited clinician awareness, fragmented IT systems, and insufficient policy alignment. Solutions include standardisation, embedding KFRE into LIMS/EHRs, automated calculation, and alignment with national strategies. CONCLUSIONS Embedding KFRE into clinical workflows offers a model for digital risk tool integration. Addressing barriers across technical, educational, and policy domains is essential, and lessons are transferable to other digital health innovations. CLINICALTRIAL N/A