Improving chronic kidney disease care through quality indicators monitoring: one year follow-up study after the introduction of a contextualized NICE guideline in Cyprus
TL;DR
Introduction of guideline-based CKD quality indicators within the Cyprus health system was associated with measurable improvements during the first year of monitoring, suggesting that structured adaptation of international guidance combined with routine quality of care monitoring may support improvements in CKD care in healthcare systems with limited prior experience in quality-of-care monitoring.
Abstract
Chronic kidney disease (CKD) represents a major public health challenge worldwide and is associated with substantial morbidity, mortality, and healthcare costs. Despite the availability of evidence-based recommendations for CKD management, significant international variability exists in their implementation and monitoring. Cyprus historically reported among the highest incidences of kidney replacement therapy (KRT) in Europe, but lacked guidelines adapted to the local context as well as a structured CKD quality-of-care monitoring framework. This manuscript describes the development and implementation of guideline-based CKD clinical quality indicators within the Cyprus General Health System (GeSY), following the contextualization of the National Institute for Health and Care Excellence (NICE) guideline NG203, and evaluates changes in quality-of-care during the first year of implementation. Through a structured adaptation process, which included a series of meetings, followed by public consultation, relevant and feasible quality indicators were contextualized and integrated into the GeSY information system. Six indicators were evaluated comparing indicator outputs between a baseline 12-month period before the introduction of the contextualized guideline (01 November 2023–31 October 2024) with a post-introduction reporting 12-month period (01 November 2024–31 October 2025). Four indicators improved following guideline introduction with significant increases observed in annual urine albumin-to-creatinine ratio testing in CKD, renal function monitoring among chronic nonsteroidal anti-inflammatory drugs users, confirmation of CKD diagnosis using repeated estimated Glomerular Filtration Rate (eGFR) testing, and combined eGFR and albuminuria assessment at diagnosis. Indicators related to pharmacological management remained largely unchanged across the two study periods. Introduction of guideline-based CKD quality indicators within the Cyprus health system was associated with measurable improvements during the first year of monitoring. These findings suggest that structured adaptation of international guidance combined with routine quality of care monitoring may support improvements in CKD care in healthcare systems with limited prior experience in quality-of-care monitoring.