Аңдатпа
Introduction: Chronic kidney disease (CKD) is a major global health challenge, affecting nearly 10% of the world's population and causing over 1 million deaths annually.The burden, however, is unequally distributed-almost 80% of people with CKD live in low-and middleincome countries, where access to diagnostics, dialysis, transplantation, and follow-up care is often limited.Health-related quality of life (HRQoL) is a critical outcome measure in CKD management, yet most evidence originates from high-income countries.This systematic review synthesizes HRQoL data specifically from low-and lowermiddle income countries (LLMICs) to generate context-specific estimates for underserved populations.Methods: Following PRISMA 2020 guidelines, we searched PubMed, Ovid MEDLINE, Scopus, and Web of Science from January 2000 onwards for studies reporting validated HRQoL measures in CKD patients from LLMICs.We classified patients into five groups: early-stage CKD (1-3), advanced non-dialysis CKD (4-5), dialysis, post-transplant, and non-stratified CKD.Random-effects meta-analyses were conducted using inverse-variance weighting for groups with $3 observations from $2 studies.Meta-regression examined sources of heterogeneity, and publication bias was assessed using Egger's test.Results: We included 124 studies involving 24,207 participants from 24 LLMICs, with India most represented (28.2%).Progressive HRQoL deterioration was evident across CKD stages.SF-36 physical component summary scores declined from 41.7 (95% CI: 38.0-45.3) in early CKD to 35.5 (32.6-38.3) in advanced non-dialysis stages.Kidney-specific domains showed similar patterns: KDQOL burden of kidney disease scores decreased from 63.0 (60.3-65.6) in early CKD to 28.2 (22.0-34.3) in dialysis patients.Kidney transplantation was associated with substantial improvements, with SF-36 physical component scores reaching 44.0 (40.7-47.4)post-transplant versus 37.7 (34.0-41.3) in dialysis patients.WHOQOL-BREF physical domain scores increased from 46.2 (40.1-51.8) in dialysis to 68.2 (56.0-80.5)post-transplant.Meta-regression revealed study quality and design as significant predictors of heterogeneity in kidney-specific domains.Publication bias was detected in several kidney-specific domains among dialysis studies.Conclusion: This first comprehensive synthesis of HRQoL data from LLMICs demonstrates progressive deterioration across CKD stages with substantial improvements following transplantation.Compared to global benchmarks largely derived from high-income countries, HRQoL scores in LLMICs are markedly lower, reflecting both the heavier patient burden and limited access to transplantation.These context-specific estimates can inform equitable service delivery, patient-centered program design, and resource allocation in resourceconstrained settings where the majority of CKD patients reside. I have potential conflict of interest to disclose.This research was