Scoping review finds late CKD diagnosis still common, with few tested interventions

Many people with chronic kidney disease are diagnosed late in the course of their illness, and a new scoping review in BMC Nephrology finds that the evidence base for reversing this pattern remains strikingly thin. The review, published on 26 October 2026, was led by Hannah O’Keeffe and colleagues including Mir Naushad Amin, Philip A. Kalra, Catherine Croucher and Smeeta Sinha, and set out to map what is known about risk factors, inequalities and intervention strategies for late presentation with chronic kidney disease.

The authors note that late presentations of chronic kidney disease continue to account for a significant proportion of cases internationally. According to the review’s background, this denies patients the opportunity to benefit from renoprotective therapies, and to be adequately prepared for either kidney replacement therapy or conservative kidney care. In other words, a delayed diagnosis does not simply postpone a label; it can close off a window in which treatment and planning could have changed the course of the disease.

To assemble the evidence, the team conducted a scoping review following PRISMA-ScR guidance. They searched three databases — PubMed, EMBASE and Cochrane — for literature published between 1 January 2013 and 31 December 2023, considering risk factors and inequalities associated with late presentation of chronic kidney disease, as well as interventions designed to address these.

The search identified 28 studies that met the inclusion and exclusion criteria. Of these, 24 pertained to risk factors for late presentation with chronic kidney disease, while only 4 presented interventions addressing late presentations. The majority of the included studies were retrospective observational cohort studies, a design that can describe associations but cannot establish causal effects of the factors being examined.

One of the review’s central findings concerns how inconsistently the problem itself is defined. The authors report significant variation in the definitions of late presentation used across studies, and in the consideration given to contributing factors. Without a shared definition, it is difficult to compare findings between studies, to pool results, or to build a coherent picture of who is being diagnosed late and why. The review’s conclusions call explicitly for the use of a standardized definition of late presentation to enable improved understanding of the issue and comparison of studies.

The intervention side of the literature was even sparser. However, only one of the included studies reported the actual impact of its intervention on late presentations. The remaining intervention studies did not evaluate whether their approach changed the rate of late diagnosis at all, leaving the field without direct evidence about what works.

Despite the limited intervention evidence, the review’s authors strike a hopeful note. They state that there is significant potential to intervene and improve earlier detection and awareness, preventing a significant proportion of late presentations. This framing positions late presentation as a modifiable systems problem rather than an inevitability, while acknowledging that the evidence for specific solutions has yet to be generated.

The review’s conclusions emphasise that there remains a need for high-quality research in this area — work that understands modifiable risk factors, examines the impact of inequality, and provides evidence for how to address the issue. As a scoping review based on 28 studies, most of them retrospective observational cohorts, the work maps the terrain rather than testing remedies. Its immediate contribution is a clearer view of the gaps: inconsistent definitions, few intervention studies, and almost no evaluations of whether interventions actually reduce late diagnoses. The authors frame filling those gaps as the necessary next step toward ensuring that fewer patients first learn of their kidney disease when options have already narrowed.

Subject of Research: Risk factors, inequalities and intervention strategies for late presentation of chronic kidney disease

Article Title: Late presentations of chronic kidney disease: a scoping review of risk factors, inequality, and intervention strategies

Article References: O’Keeffe, H., Amin, M. N., Kalra, P. A., Croucher, C., & Sinha, S. (2026). Late presentations of chronic kidney disease: a scoping review of risk factors, inequality, and intervention strategies. BMC Nephrology. https://doi.org/10.1186/s12882-026-05454-3

Image Credits: AI Generated

DOI: 10.1186/s12882-026-05454-3

Keywords: chronic kidney disease, late presentation, scoping review, PRISMA-ScR, risk factors, health inequality, eGFR reporting, early detection, kidney replacement therapy, BMC Nephrology, retrospective cohort studies, standardized definition