Effectiveness of Multicomponent Interventions in Slowing Progression of CKD Stages G3-G4: A Systematic Review and Meta-Analysis.

KEY POINTS: Multicomponent interventions with two or more intervention strategies are increasingly used to manage patients with CKD G3-G4. 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. Among multicomponent interventions, physician-led team-based care seemed superior to non-physician-led team-based care, albeit the clinical relevance of the benefit was modest.

BACKGROUND

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.

METHODS

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.

RESULTS

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 2 ; 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 2 /yr; 95% CI, 0.16 to 1.06; six trials, moderate certainty of evidence), and a moderate reduction in HbA1c (MD=-0.26; 95% CI, -0.49 to-0.02; nine trials, low certainty of evidence). No statistically significant effects were observed for albuminuria, BP, or adverse events.

CONCLUSIONS

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.