{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T14:05:47Z","timestamp":1789135547587,"version":"build-2803163510"},"reference-count":48,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Nephrosearch Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Older patients with chronic kidney disease (CKD) often experience relatively slow kidney function decline, suggesting that, despite meeting referral criteria, primary care management may be appropriate. We assessed guideline recommended CKD management in patients with CKD stage 4\u20135 across primary and nephrology care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Population-based study using routine healthcare data from primary care and hospitals, including patients \u226565 years with incident or prevalent estimated glomerular filtration rate (eGFR) &amp;lt;30 ml\/min\/1.73 m2 between 2015 and 2024. Guideline adherence was evaluated using 13 quality indicators, calculated as the proportion of patients fulfilling these indicators or the proportion of follow-up time covered by adherent care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 1969 patients (mean age 81.8 years, median eGFR 25 ml\/min\/1.73 m2), 61.2% were managed in primary care. These patients were older and were more often considered frail. In primary care, adequate monitoring covered 82.5% of follow-up time for kidney function (recommended twice yearly), 47.8% for albuminuria, 76.6% for blood pressure, 85.6% for haemoglobin, 50.9% for low-density lipoprotein-cholesterol, and 68.3% for HbA1c among patients with diabetes, all of which were recomended to be monitored annually. Corresponding estimates in nephrology care were 86.8%, 65.2%, 84.4%, 97.5%, 68.3%, and 84.9%, respectively. Monitoring of metabolic complications, which falls beyond primary care guidelines, was 28.4%\u201379.2% in primary care and 73.6%\u201397.8% in nephrology care. Renin\u2013angiotensin\u2013aldosterone inhibitors were prescribed in 56.9% (primary care) and 84.4% (nephrology care); sodium-glucose co-transporter 2 inhibitors in 4.3% and 10.1%, and nonsteroidal anti-inflammatory drugs (NSAIDs) in both settings &amp;lt;7%. Guideline adherence did not vary by socio-economic status or country of origin. In primary care, adherence was higher in patients with diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The majority of older patients with CKD stage 4\u20135 are managed in primary care. Guideline adherence varied across care settings, which serve substantially different patient populations. Higher adherence in patients with diabetes, typically enrolled in structured disease management programs, suggests that embedding similar structured approaches may enhance adherence to CKD guideline in primary care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ndt\/gfag171","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T11:39:09Z","timestamp":1785843549000},"source":"Crossref","is-referenced-by-count":0,"title":["CKD-guideline adherence in primary and nephrology care for older patients with advanced CKD"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3600-2860","authenticated-orcid":false,"given":"Micha","family":"Jongejan","sequence":"first","affiliation":[{"name":"Leiden University Medical Center Department of Internal Medicine, , Leiden ,","place":["the Netherlands"]},{"name":"Leiden University Medical Center, Health Campus the Hague Department of Public Health and Primary Care, , the Hague ,","place":["the 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