Marco Boonstra

54 We found high quality studies to be scarce. This shows a need for larger cohort and intervention studies to unravel the mechanisms by which LHL leads to worse health outcomes and to assess the effectiveness of HL-tailored interventions to improve these outcomes. Such research should include studies on earlier stages of CKD in various parts of the world to find ways to prevent kidney deterioration among people with LHL. Additionally, research is needed to adapt the activities of health care organizations to the needs of patients with LHL, for example by strengthening the communication capacities of professionals. This may help to better inform patients with LHL and improve communication between these patients and professionals[99]. In conclusion, despite the call for urgency in the research agenda on CKD and HL in 2009[17], effective intervention targets and strategies are still lacking. We urgently need funding agencies, policy makers, researchers, and health care professionals to take the lead in efforts to improve the health outcomes of CKD patients with LHL. This should lead to unraveling of the mechanisms and targeting of LHL-associated mediating factors with HL-interventions, especially in earlier stages of CKD, to slow down and prevent the global rise of kidney disease.

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