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Additional file 2. PRISMA 2020 flow diagram.

Additional file 1. PubMed Search Strategy.

Additional file 4. Funnel plot on HbA1c.

Additional file 8. Forest plot showing the effect of CCM on post-intervention BMI (kg/m2). IV, inverse variance.

Additional file 5. Table with numbers of CCM elements found in the interventions for each trial.

Additional file 9. Forest plot showing subgroup analysis of post-intervention HbA1c (%) according to study duration. IV, inverse variance.

Additional file 7. Forest plot showing the effect of CCM on post-intervention LDL cholesterol (mmol/L). IV, inverse variance.

Additional file 6. Risk of bias.

BackgroundChronic kidney disease (CKD) is common in the older population. By 2035, approximately one-quarter of Singapore residents are expected to have CKD. Many of these patients are not referred to nephrologists.AimTo compare the characteristics of older patients (aged ≥65 years) with CKD stage ≥3B in the referral and non-referral groups.Design & settingsA cross-sectional study in the primary care organisation National University Polyclinics (NUP), Singapore.MethodRetrospective data were extracted from the electronic health records of patients with CKD (aged ≥65 years) with CKD stage ≥3B.ResultsFrom 1 January–31 December 2018, a total of 1536 patients aged ≥65 years were diagnosed with CKD stage ≥3B (non-referral group = 1179 versus referral group = 357). The mean patient age in the non-referral group (78.4 years) was older than that in the referral group (75.9 years) (PP = 0.008). The non-referral group was prescribed significantly less fibrate, statins, insulin, sulfonylureas, dipeptidyl peptidase-4 (DPP4) inhibitors, and antiplatelet than the referral group (PConclusionThis study demonstrates that there is a considerable number of older patients with CKD exclusively managed in the primary care setting (n = 1179) and that referrals primarily depend on demographic factors, namely age and ethnic group, rather than medical determinants of CKD severity or case complexity.