Implementation Strategies to Improve CKD Testing and Delivery of Guideline-Directed Medical Therapy: A Scoping Review

Background: Chronic kidney disease (CKD) remains underdiagnosed and undertreated despite substantial cardiovascular and mortality risks. Guidelines recommend annual testing with estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) in at-risk populations, and a growing number of guideline-directed medical therapies (GDMT) improve kidney and cardiovascular outcomes in CKD. We conducted a scoping review of controlled implementation studies to identify effective strategies for improving CKD testing and GDMT delivery and define priorities for future implementation trials. Methods: Following a registered protocol and PRISMA extension for Scoping Reviews (PRISMA-ScR) guidance, we searched MEDLINE, Embase, and the Web of Science Core Collection from database inception through June 9, 2026 for English-language prospective controlled studies. Eligible studies compared an implementation strategy with usual care or another control condition. We charted study characteristics and outcomes using standardized templates and synthesized findings by objective, strategy, setting, design, and target population. Results: We included 26 reports from 24 studies (N=7 testing, N=17 treatment). Six of 7 studies increased CKD testing, with the largest gains from patient-directed home testing and automated laboratory ordering paired with clinical decision support. However, increased testing seldom translated into increased CKD diagnosis or GDMT prescriptions. Of implementation efforts focused on CKD treatment, only 5 of 17 studies increased GDMT prescribing. Passive, single-touch strategies, including isolated alerts, one-time prompts, and registries without active outreach, rarely changed prescribing. In contrast, longitudinal strategies that incorporated pharmacist- or advanced practice provider-led management, nephrologist-supported multidisciplinary care, or proactive registry-based outreach more consistently increased GDMT exposure and sometimes improved intermediate clinical outcomes. Conclusions: Among 24 prospective controlled studies, patient-directed home testing and automated laboratory ordering paired with clinical decision support increased CKD testing, but increased testing seldom led to CKD diagnosis or GDMT prescribing. Only 5 of 17 treatment studies increased GDMT prescribing, all through longitudinal, team-based care.