Surreal illustration of kidney health and quality improvement.

CKD Management: Can Quality Improvement Strategies Make a Difference?

Kai Mendoza in Health & Wellness December 2025 • 4 min read.

"A meta-analysis reveals the effectiveness of quality improvement interventions in managing Chronic Kidney Disease (CKD) and improving patient outcomes."

Chronic Kidney Disease (CKD) affects approximately 10% of adults in North America, requiring multifaceted care to manage disease progression and complications. This includes addressing hypertension, proteinuria, cardiovascular health, and bone health. Despite clinical practice guidelines, many CKD patients do not receive optimal care, highlighting a significant gap in treatment efficacy.

Quality improvement (QI) interventions aim to continually strengthen healthcare system performance and can help bridge these care gaps within the CKD population. By targeting various aspects of healthcare delivery—from the system itself to individual providers and patients—QI strategies have proven successful in managing other chronic conditions. For instance, in diabetes mellitus, QI strategies have been linked to notable reductions in glycated hemoglobin (HbA1c), blood pressure, and LDL cholesterol levels.

While the potential of QI interventions in CKD management is recognized, it remains unclear which specific strategies are most effective. To address this knowledge gap, a systematic review and meta-analysis was conducted to synthesize available literature on QI strategies for CKD patients and to describe their impact on clinical outcomes.

The Impact of Quality Improvement Strategies on CKD Care

Surreal illustration of kidney health and quality improvement.

The systematic review included 21 studies, comprising 15 patient-level randomized trials (3,298 patients) and six cluster-randomized trials (30,042 patients). These studies evaluated the effectiveness of various QI strategies on different clinical outcomes relevant to CKD management.

Key findings from the meta-analysis indicated that QI strategies led to:

Reduced Dialysis Incidence: Seven trials showed that QI strategies reduced the incidence of dialysis (RR, 0.85; 95% CI, 0.74 to 0.97), suggesting a significant impact on slowing disease progression.
Improved LDL Cholesterol Concentrations: Four trials demonstrated that QI interventions lowered LDL cholesterol concentrations (mean difference, -17.6 mg/dL; 95% CI, -28.7 to -6.5), highlighting benefits for cardiovascular health.
Increased Use of Renin-Angiotensin-Aldosterone System Inhibitors: Nine trials indicated that QI strategies increased the likelihood of patients receiving renin-angiotensin-aldosterone system inhibitors (RR, 1.16; 95% CI, 1.06 to 1.27), crucial for managing blood pressure and proteinuria.

The meta-analysis did not find statistically significant effects on mortality, cardiovascular events, eGFR, glycated hemoglobin, and systolic or diastolic BP. These outcomes may require longer follow-up periods or more targeted interventions to demonstrate significant changes.

Looking Ahead: Optimizing CKD Care with QI Strategies

Quality improvement interventions show promise in enhancing specific aspects of CKD care, particularly in reducing dialysis incidence, improving LDL cholesterol levels, and increasing the use of essential medications. While the effectiveness estimates are currently limited by the number of studies and adherence to QI principles, these findings underscore the potential for QI strategies to materially improve patient outcomes and healthcare delivery in CKD management. Future research should focus on addressing existing gaps, refining QI methodologies, and ensuring fidelity to QI principles to maximize the impact on a broader range of clinical outcomes.

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This article is based on research published under:

DOI-LINK: 10.2215/cjn.02490317, Alternate LINK

Title: Effectiveness Of Quality Improvement Strategies For The Management Of Ckd

Subject: Transplantation

Journal: Clinical Journal of the American Society of Nephrology

Publisher: American Society of Nephrology (ASN)

Authors: Samuel A. Silver, Chaim M. Bell, Glenn M. Chertow, Prakesh S. Shah, Kaveh Shojania, Ron Wald, Ziv Harel

Published: 2017-09-06

Everything You Need To Know

What is Chronic Kidney Disease (CKD), and why is it important to understand in this context?

Chronic Kidney Disease (CKD) is a condition where the kidneys are damaged and can't filter blood as well as they should. It affects approximately 10% of adults in North America. Its management involves addressing hypertension, proteinuria, cardiovascular health, and bone health, because these factors contribute to CKD progression and its complications. Understanding CKD and its management is essential for the effective implementation of Quality Improvement (QI) strategies.

What are Quality Improvement (QI) interventions, and why are they significant in managing CKD?

Quality improvement (QI) interventions are strategies designed to enhance healthcare system performance. They are important in the context of CKD because, despite clinical practice guidelines, many CKD patients don't receive optimal care. QI interventions bridge these care gaps by targeting various aspects of healthcare delivery, from the system to providers and patients. By implementing QI strategies, healthcare providers can improve outcomes and healthcare delivery in CKD management.

What were the main findings of the meta-analysis regarding the impact of QI strategies on CKD care?

The meta-analysis revealed that QI strategies led to reduced Dialysis Incidence, improved LDL Cholesterol Concentrations, and increased Use of Renin-Angiotensin-Aldosterone System Inhibitors. The reduction in Dialysis Incidence suggests that QI interventions can slow disease progression. Improved LDL Cholesterol Concentrations highlight the benefits for cardiovascular health. Increased use of Renin-Angiotensin-Aldosterone System Inhibitors, which are crucial for managing blood pressure and proteinuria, is another positive impact.

What outcomes did the meta-analysis not find statistically significant effects on?

The meta-analysis did not find statistically significant effects on mortality, cardiovascular events, eGFR, glycated hemoglobin, and systolic or diastolic BP. This means that while some areas of CKD care showed improvement, other critical outcomes didn't significantly change within the studies' timeframe. Longer follow-up periods or more targeted interventions might be needed to demonstrate the impact on these outcomes.

What are the recommendations for future research to improve CKD care with QI strategies?

Future research should focus on addressing existing gaps, refining QI methodologies, and ensuring adherence to QI principles. This will maximize the impact on a broader range of clinical outcomes. This includes determining what specific strategies are most effective in managing Chronic Kidney Disease, leading to optimized CKD care. Such actions will materially improve patient outcomes and healthcare delivery in CKD management.