Stage 3 addresses the analysis, interpretation, and communication of CKDu findings. Reporting decisions influence how results are understood by communities, researchers, and policymakers, as well as the comparability of findings across regions. The i3C framework emphasizes clarity, cautious interpretation, and transparency regarding uncertainty during this stage.
Analytic strategies must align with the study design, data quality, and original hypotheses, while recognizing the inherent limitations of CKDu research. The i3C framework underscores the need for analytic rigor to prevent errors in interpretation, especially in contexts with complex exposures and evolving outcomes.
Key principles include:
- Pre-specify analytic plans that correspond to the study objectives, such as burden estimation, etiological exploration, progression, or intervention assessment, rather than relying on post hoc analyses.
- Conduct descriptive analyses to clearly characterize the study population, screening pathways, and patterns of missing data prior to applying inferential models.
- Select analytic methods that address measurement error, exposure misclassification, and clustering by geography or occupation, as appropriate.
- Avoid making causal claims that are not supported by the study design. Associations should be presented as hypothesis-generating unless a stronger inference is warranted, particularly when results may inform policy decisions.
- Clearly document assumptions, sensitivity analyses, and analytical constraints to facilitate appropriate interpretation and reuse of results across regions.
Local reporting represents a critical yet frequently underdeveloped aspect of CKDu research. The i3C framework emphasizes that findings must be communicated responsibly, with careful consideration of social, ethical, and health system implications.
Good practice includes:
- Develop a local reporting plan prior to finalizing results, specifying the information to be shared, the intended recipients, and the dissemination format.
- Communicate results to communities in an accurate, respectful, and proportionate manner, avoiding language that suggests blame, certainty of causation, or unwarranted immediate clinical action.
- Ensure that abnormal clinical findings identified through research are accompanied by clear referral pathways and practical guidance, thereby providing appropriate support to participants.
- Manage sensitive information, particularly regarding occupational or environmental exposures, in ways that protect individuals and communities from stigma or unintended consequences.
- Coordinate messaging with local health authorities to prevent conflicting interpretations or misuse of preliminary findings.
Authorship decisions in CKDu research must reflect both scientific contributions and ethical collaboration. The i3C reports emphasize that transparent authorship practices foster trust, support capacity building, and strengthen long-term research partnerships.
Recommended practices include:
- Establish authorship principles at an early stage, including criteria for inclusion, author order, and acknowledgment of non-author contributions.
- Recognize contributions from local investigators, field teams, and partner institutions, especially when studies depend significantly on local knowledge and infrastructure.
- Avoid extractive practices in which data is generated locally but interpreted and published without meaningful local involvement.
- Clearly document roles in study conception, data collection, analysis, and manuscript preparation to ensure fair attribution.
- Encourage mentorship and capacity strengthening through shared authorship, where appropriate, in accordance with international publication standards.