Late presentations of chronic kidney disease: a scoping review of risk factors, inequality, and intervention strategies

Background Late presentations of chronic kidney disease (CKD) continue to account for a significant proportion of cases internationally. This denies patients the opportunity to benefit from renoprotective therapies, and to be adequately prepared for kidney replacement therapy or conservative kidney care. Methods We conducted a scoping review following PRISMA-ScR guidance, considering risk factors and inequalities associated with late presentations of CKD, and interventions to address these. A comprehensive search was conducted of three databases; PubMed, EMBASE and Cochrane from 1/1/2013 through 31/12/2023. Results 28 studies were identified meeting the inclusion and exclusion criteria; 24 pertaining to risk factors for late presentation with chronic kidney disease, and 4 presenting interventions addressing late presentations. The majority of studies were retrospective observational cohort studies. Significant variation was found in the definitions of late presentations, and in the consideration of contributing factors. All of the interventions designed to address late presentations involved estimated glomerular filtration rate reporting. Only one reported the actual impact of the intervention on late presentations. There is significant potential to intervene and improve earlier detection and awareness, preventing a significant proportion of late presentations. Conclusions There remains a need for high-quality research in this area, understanding modifiable risk factors, the impact of inequality and providing evidence for how to address this issue. The use of a standardized definition of late presentation is required to enable improved understanding of the issue and comparison of studies. Clinical trial number Not applicable.