meta-analyses to impact on study design, conduct and analysis. Naturally, this collaborative endeavour has both strengths and limitations. The variation in populations is one of the strengths of this network. Given the distribution of studies across Africa, the populations are genetically distinct, which will provide insights on possible genetic determinants of CKD. Furthermore, these populations also differ greatly with respect to health behaviours, healthcare delivery and environments. Conversely, while commonalities in study design will facilitate joint analysis, inconsistencies in the definition and capture of variables, as well as adjudication of outcomes, can complicate analyses. For example, the Jaffe method is less expensive and more readily used in the included studies compared with enzymatic assay but is more susceptible to interference from various biomolecules, like glucose.61 However, despite the lack of standardisation of measurements of common laboratory parameters, calibration may be achieved by statistical means, given detailed descriptions of the collection processes. Also, this network can provide a unique opportunity to improve the quality of creatinine measurements by examining External Quality Assurance data of participating laboratories and encouraging those laboratories that are not participating in such programmes to do so. This allows for peer comparison and to ensure that methods being used are traceable to an internationally recognised standard. This will allow for greater precision and accuracy of eGFR measurements and permit comparisons. We do acknowledge that a single time point for serum creatinine determination for CKD diagnosis by eGFR, rather than over 3months as recommended,23 is not ideal. However, given the resource-poor settings in most of Africa, the probability of receiving data on repeated measures is low. Another limitation is the potential risk of participant duplication, where the same individual participates in different studies. Since we receive deidentified data, the various collaborators will on July 8, 2022 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2021-006454 on 4 August 2021. Downloaded from 8 George C, et al. BMJ Global Health 2021;6:e006454. doi:10.1136/bmjgh-2021-006454 BMJ Global Health be required to inform the secretariat of such potential for duplication. A major limitation currently is that nearly 61% of the identified PIs have not yet responded to our call or are unwilling to participate in the network. Due to the potential large data contribution by these studies, the risk of significant bias could be introduced into our analysis. However, enrolment into the consortium continues and, to minimise the risk of bias, as far as possible, analyses will include both IPD and aggregated data from the published studies for which IPD is unavailable. In its current form, the network is only represented by 12 countries (22%) of the 54 countries in Africa, with most IPD coming from South Africa. However, with that said, this network covers all five subregions of Africa and as this is a growing network, the number of enrolled studies is expected to increase substantially over the coming years. CONCLUSION This network will aid research in the field of CKD on the African continent. With this platform to facilitate interactions among active investigators, the commitment of all teams currently involved and the broadly defined research agenda, we are confident that there will be new studies across Africa, particular in the currently under-represented countries, that will join the network. In addition, we foresee the development of new studies originating from this collaboration. In that regard, this network has far-reaching potential for Africa, as it is in an ideal position to validate findings across geographical and national boundaries, to test hypotheses and to generate a new understanding of CKD progression and its complications. Although the CKD-Africa Collaboration is focused primarily on CKD, many of our lessons learnt can be applied more widely in public health research in LMICs. Author affiliations 1 Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa 2 Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa 3 Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada 4 Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa 5 The George Institute for Global Health, Department of Epidemiology and Biostatistics, Imperial College, London, UK 6 The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia 7 Department of Medicine, University of Cape Town, Cape Town, South Africa Acknowledgements We would like to acknowledge the South African Medical Research Council (SAMRC) for infrastructure and support. Also, we are very grateful to the collaborators for showing keen interest in collaborating in this network and their continued participation, as well as all the participants from each primary study for allowing their data to be incorporated into this network. Collaborators T A Adedeji; C Agyemang; A Akinsola; D D Alasia; O E Ayodele; E J Beune; P Bovet; J Cailhol; D R Chadwick;