{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T07:02:27Z","timestamp":1779778947757,"version":"3.53.1"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Background<\/jats:title>\n Chronic kidney disease (CKD) has emerged as a leading chronic condition contributing to global mortality and disability. Its early stages are often asymptomatic, leading to delayed detection. In China\u2019s western ethnic minority regions, characterized by geographical dispersion, insufficient primary healthcare resources, and relatively low public health literacy, the early identification and effective management of CKD face more complex challenges.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n Focusing on the Qiandongnan Miao and Dong Autonomous Prefecture in Guizhou Province as the study area, this research aimed to construct an integrated model for CKD early screening and tiered management adapted to regional characteristics. It sought to identify key barrier factors and assess the feasibility and application potential of the model in real-world primary care settings.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Employing a multi-data source study design combining cross-sectional surveys with integrated real-world clinical data, the study was conducted in Qiandongnan Prefecture. Data collection involved public questionnaires (\n n<\/jats:italic>\n \u202f=\u202f1,769) and surveys of primary healthcare workers (n\u202f=\u202f960), alongside the collation of regional urine albumin-to-creatinine ratio (ACR) testing data and renal biopsy\/pathological spectrum information. Primary outcome measures included public CKD awareness levels, screening behavior participation, primary healthcare worker management competency, ACR testing coverage, and CKD clinical staging with pathological type distribution. Secondary measures encompassed associations between public behavior and screening testing, as well as resource availability and capacity differentiation among primary care institutions. Analytical methods included descriptive statistics, multivariable regression analysis, and latent class analysis.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Overall public CKD awareness was low, and screening behavior participation was limited; however, a significant positive correlation existed between the two. Primary healthcare workers exhibited stratified competency in risk assessment, indicator application, and management pathway knowledge. ACR testing rates were constrained by both behavioral willingness and technical resource limitations. Most CKD patients were in G1\u2013G2 stages, with primary glomerular diseases constituting the predominant pathological type. The integrated model demonstrated good operational feasibility in optimizing screening pathways and enhancing tiered management capacity.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The integrated CKD early screening and tiered management model constructed in Qiandongnan Prefecture demonstrates the feasibility of linking behavioral, institutional, and clinical dimensions for early detection and management, as it integrates public awareness, primary care capacity, and clinical data into a unified framework. Its methodological contribution lies in the use of multi-source data and latent class analysis, while its practical contribution includes the identification of critical breakpoints and actionable recommendations for screening, ACR testing, and health education. Future directions should focus on longitudinal validation, application in other regions, and incorporation of advanced predictive models, and results should be interpreted in the context of regional characteristics and resource limitations.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1809153","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T06:04:24Z","timestamp":1779775464000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Construction and regional application of an integrated model for early screening and tiered management of chronic kidney disease"],"prefix":"10.3389","volume":"14","author":[{"given":"Guoying","family":"Ma","sequence":"first","affiliation":[{"name":"Department of Nephrology, The People's Hospital of the Qiandongnan Miao and Dong Autonomous Prefecture","place":["Kaili, Guizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoran","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The People's Hospital of the Qiandongnan Miao and Dong Autonomous Prefecture","place":["Kaili, Guizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqin","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The People's Hospital of the Qiandongnan Miao and Dong Autonomous Prefecture","place":["Kaili, Guizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The People's Hospital of the Qiandongnan Miao and Dong Autonomous Prefecture","place":["Kaili, Guizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cendan","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The People's Hospital of the Qiandongnan Miao and Dong Autonomous Prefecture","place":["Kaili, Guizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2461","DOI":"10.1016\/S0140-6736(25)01853-7","article-title":"Global, regional, and national burden of chronic kidney disease in adults, 1990-2023, and its attributable risk factors: a systematic analysis for the global burden of disease study 2023","volume":"406","year":"2025","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"101776","DOI":"10.1016\/j.lanwpc.2025.101776","article-title":"Chronic kidney disease burden from 1990 to 2023 in China: national and provincial insights from the global burden of diseases study 2023","volume":"68","author":"He","year":"2025","journal-title":"Lancet Reg Health West Pac"},{"key":"ref3","year":""},{"key":"ref4","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1016\/S0140-6736(25)01942-7","article-title":"Chronic kidney disease","volume":"407","author":"Herrington","year":"2026","journal-title":"Lancet"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1016\/j.kint.2023.10.016","article-title":"Executive summary of the KDIGO 2024 clinical practice guideline for the evaluation and Management of Chronic Kidney Disease: known knowns and known unknowns","volume":"105","author":"Levin","year":"2024","journal-title":"Kidney Int"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1161\/CIRCULATIONAHA.113.007106","article-title":"Risk of end-stage renal disease and death after cardiovascular events in chronic kidney disease","volume":"130","author":"Sud","year":"2014","journal-title":"Circulation"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"299","DOI":"10.3390\/economies11120299","article-title":"Modelling health financing performance in Europe in the context of macroeconomic uncertainties","volume":"11","author":"Dinc\u0103","year":"2023","journal-title":"Economies"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e0334693","DOI":"10.1371\/journal.pone.0334693","article-title":"Health systems performance in health outcomes, health financing and COVID-19 pandemic: lessons from 31 countries","volume":"20","author":"Kolivand","year":"2025","journal-title":"PLoS One"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"104997","DOI":"10.1016\/j.healthpol.2024.104997","article-title":"Theories, models and frameworks for health systems integration. 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