{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:53:15Z","timestamp":1786373595173,"version":"build-2736575974"},"reference-count":69,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","funder":[{"DOI":"10.13039\/501100001349","name":"Singapore National Medical Research Council","doi-asserted-by":"crossref","award":["Senior Clinician Scientist Award"],"award-info":[{"award-number":["Senior Clinician Scientist Award"]}],"id":[{"id":"10.13039\/501100001349","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Multicomponent interventions with two or more intervention strategies are increasingly used to manage patients with CKD G3-G4.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Existing multicomponent interventions had a modest effect on slowing CKD progression, although the certainty of evidence was low for eGFR and moderate for eGFR slope.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Among multicomponent interventions, physician-led team-based care seemed superior to non\u2013physician-led team-based care, albeit the clinical relevance of the benefit was modest.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Various multicomponent interventions (MCIs) have been increasingly used for managing patients with CKD G3-G4, but they have not been systematically evaluated for the collective evidence of their effectiveness. Hence, we conducted this systematic review and meta-analysis to evaluate the effectiveness of MCIs in delaying CKD progression and improving health outcomes in patients with CKD G3-G4.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We completed a systematic literature search in PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Cumulative Index to Nursing and Allied Health Literature from inception to July 30, 2025. We included randomized controlled trials studying the effectiveness of MCIs lasting at least 6 months among patients with CKD G3-G4. We used random-effects meta-analyses to estimate the effectiveness of MCIs on the primary outcome, eGFR, and secondary outcomes, including other kidney function indicators, CKD risk factors, and adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nineteen randomized controlled trials (36,296 patients with CKD G3-G4; median follow-up of 24 months) were included. Components of MCI included a mix of behavioral modifications, guideline-directed medical therapy, enabling technology components, and team-based care. Compared with control, MCIs were associated with small improvements in eGFR (mean difference [MD]=1.18 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      ; 95% confidence interval [CI], 0.09 to 2.27; 19 trials, low certainty of evidence), eGFR slope (MD=0.61 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      \/yr; 95% CI, 0.16 to 1.06; six trials, moderate certainty of evidence), and a moderate reduction in HbA1c (MD=\u22120.26; 95% CI, \u22120.49 to\u22120.02; nine trials, low certainty of evidence). No statistically significant effects were observed for albuminuria, BP, or adverse events.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings suggest the potential role of MCIs in delaying CKD progression and improving glycemic control among patients with CKD G3-G4. Nonetheless, the certainty of evidence is low for eGFR and HbA1c and moderate for eGFR slope, suggesting overall modest clinical relevance. High-quality studies are needed to confirm the effectiveness, cost-effectiveness, and scalability of MCIs for this high-risk patient group.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.0000000996","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T17:00:50Z","timestamp":1771347650000},"page":"924-937","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of Multicomponent Interventions in Slowing Progression of CKD Stages G3-G4"],"prefix":"10.2215","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5239-8530","authenticated-orcid":false,"given":"Chenxinan","family":"Ma","sequence":"first","affiliation":[{"name":"Program in Health Services Research and Population Health, Duke-NUS Medical School, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Wu","sequence":"additional","affiliation":[{"name":"Global Health Research Center, Duke Kunshan University, Kunshan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7616-5555","authenticated-orcid":false,"given":"Yaxi","family":"Li","sequence":"additional","affiliation":[{"name":"Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8178-0951","authenticated-orcid":false,"given":"Bolu","family":"Yang","sequence":"additional","affiliation":[{"name":"School of Public Health, Wuhan University, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0274-1625","authenticated-orcid":false,"given":"Jie","family":"Tan","sequence":"additional","affiliation":[{"name":"Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9850-319X","authenticated-orcid":false,"given":"Sibo","family":"Liu","sequence":"additional","affiliation":[{"name":"Program in Health Services Research and Population Health, Duke-NUS Medical School, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9046-5105","authenticated-orcid":false,"given":"Fahad Javaid","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Program in Health Services Research and Population Health, Duke-NUS Medical School, Singapore, Singapore"},{"name":"Pre-Hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8902-2710","authenticated-orcid":false,"given":"Mihir","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Biostatistics, Singapore Clinical Research Institute, Consortium for Clinical Research and Innovation, Singapore, Singapore"},{"name":"Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7454-8376","authenticated-orcid":false,"given":"Tazeen H.","family":"Jafar","sequence":"additional","affiliation":[{"name":"Program in Health Services Research and Population Health, Duke-NUS Medical School, Singapore, Singapore"},{"name":"Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore"},{"name":"Duke Global Health Institute, Duke University, Durham, North 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