Table 3.

Barriers to diagnosis and management of CKD in primary care, as reported in included studies (studies listed by reference number)

	[22]	[7]	[32]	[29]	[30]	[23]	[8, 34]	[33]	[24]	[5, 36]	[25]	[31]	[6]	[9]	[26]	[27]	[37]	[10]	[35]	[28]
Beliefs about capabilities
Challenges educating patients								X											X
Challenging nature of CKD management							X									X		X
Beliefs about consequences
Cost and/or burden for patients				X			X
Fear of frightening patients with diagnosis	X	X	X					X	X				X	X	X			X	X
Lower priority of CKD as a clinical issue	X	X						X				X		X					X
Perception that kidney decline is to be expected in aging		X	X										X						X
Reactive focus to healthcare										X
Environmental context and resources
Challenges using laboratory measures for CKD diagnosis or management			X				X					X
Inadequacy of reporting process to support quality improvement																				X
Lack of patient education resources							X	X									X
Lack of renumeration for CKD	X													X
Limited access to nephrology							X			X							X		X
Technological issues				X					X											X
Time/workload	X		X	X	X		X	X				X	X	X	X	X			X	X
Variation in practice style	X
Knowledge
Dissatisfaction with guidelines			X				X		X		X	X	X			X		X	X	X
Lack of awareness of guidelines			X	X			X													X
Lack of awareness of resources/support services																X	X
Perceived lack of adequate knowledge or training			X				X							X		X	X	X	X	X
Perceived lack of clear definition of CKD																			X
Perceptions about patients
Lack of patient understanding of CKD					X		X	X										X
Perceived low patient adherence			X		X					X		X								X
Social influences
Poor communication between healthcare providers					X		X			X						X	X		X
Social/professional role and identity
Lack of clear role delineation between healthcare providers		X		X			X			X		X				X
Perception of role by other healthcare providers	X					X	X			X				X					X
Patient perception of roles of healthcare provider/s					X		X							X