Current Practice and Guideline Adherence in Renal Dose Adjustment for Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Current Practice and Guideline Adherence in Renal Dose Adjustment for Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 25 March 2026 V1 Latest version Share on Current Practice and Guideline Adherence in Renal Dose Adjustment for Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis Authors : Hager ElGeed 0000-0003-4187-9827 , Ahmed Tehemar 0009-0004-5563-9204 , Mohamed Gasimelseed , Ahmed Gharaibeh 0009-0007-1323-2053 , Muhammad Hadi 0000-0003-0108-7833 , Kazeem Babatunde Yusuff , Amani Zidan 0000-0002-2859-1370 , and Ahmed Awaisu 0000-0002-9029-8925 [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.177444935.51452573/v1 147 views 58 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Aims To quantify adherence to renal dosing recommendations in adults with advanced chronic kidney disease (CKD; stages 3–5, including dialysis) and to evaluate the clinical consequences of non-adherence. Methods This systematic review and meta-analysis was conducted in accordance with PRISMA 2020 and registered in PROSPERO (CRD42025620883). Eight electronic databases were searched from inception to 31 December 2025. Quantitative studies assessing renal dose adjustment practices in adults with advanced CKD were included. Two reviewers independently performed study selection, data extraction, and quality assessment using the Newcastle–Ottawa Scale and ROBINS-I. Random-effects meta-analyses (REML) were used to pool adherence proportions at prescription/order and patient levels. Results Thirty studies were included. Observational studies were of moderate to high quality (NOS 6–9/9), while two interventional studies had moderate risk of bias due to confounding. Adherence ranged from 33% to 83%. Pooled prescription/order-level adherence (n=16) was 48% (95% CI 0.42–0.55; I 2 ≈98%). Patient-level adherence (n=7) was higher at 70% (95% CI 0.57–0.83; I 2 ≈99.9%). Non-adherence was associated with adverse drug events, including hypoglycemia and nephrotoxicity, and with increased emergency department visits, hospitalizations, and mortality. Conclusions Adherence to renal dosing recommendations in advanced CKD is suboptimal and highly variable across settings. Interventions targeting prescribing systems, including clinical decision support tools, are warranted to improve guideline adherence and medication safety in this high-risk population. Supplementary Material File (renal dosing srma_hg_mah_ky_aa_v11_24 mar. 2026.docx) Download 210.00 KB File (tables and figures_hg_mah_ky_aa_v14_24 mar. 2026.docx) Download 635.61 KB Information & Authors Information Version history V1 Version 1 25 March 2026 Copyright This work is licensed under a Non Exclusive No Reuse License. Authors Affiliations Hager ElGeed 0000-0003-4187-9827 Qatar University College of Pharmacy View all articles by this author Ahmed Tehemar 0009-0004-5563-9204 Qatar University College of Pharmacy View all articles by this author Mohamed Gasimelseed Qatar University College of Pharmacy View all articles by this author Ahmed Gharaibeh 0009-0007-1323-2053 Qatar University College of Pharmacy View all articles by this author Muhammad Hadi 0000-0003-0108-7833 Qatar University College of Pharmacy View all articles by this author Kazeem Babatunde Yusuff Qatar University College of Pharmacy View all articles by this author Amani Zidan 0000-0002-2859-1370 Qatar University View all articles by this author Ahmed Awaisu 0000-0002-9029-8925 [email protected] Qatar University College of Pharmacy View all articles by this author Metrics & Citations Metrics Article Usage 147 views 58 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Hager ElGeed, Ahmed Tehemar, Mohamed Gasimelseed, et al. Current Practice and Guideline Adherence in Renal Dose Adjustment for Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Authorea . 25 March 2026. DOI: https://doi.org/10.22541/au.177444935.51452573/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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