Habtamu AberaDebela GelaSimbo Tafa2026-11-132026-11-132026-06-25https://etd.aau.edu.et/handle/123456789/9573Background: Chronic kidney disease (CKD) is increasing public health concern globally. Chronic kidney disease is asymptomatic in its early stages, leading to delayed diagnosis, late presentation, and late referral. Despite the high prevalence of chronic kidney disease, early screening and timely referral practices at the primary health care (PHC) level remain limited in Ethiopia. Objective: This study aims to explore the health system related barriers of chronic kidney disease screening and referral practices in PHC settings, 2026. Methods: A descriptive qualitative study was conducted in selected public health centers of Addis Ababa from January to March 2026. A total of 24 in-depth interviews were conducted with healthcare providers and managers selected purposively, along with 2 focus group discussions with high-risk chronic kidney disease patients. Audio-recorded data were transcribed, translated, and analyzed thematically using ATLAS.ti 9. Result: The study identified six thematic barriers to chronic kidney disease screening and referral. Service delivery barriers included neglected screening, weak referral pathways, and poor continuity of care. Workforce and information system barriers were inadequate chronic kidney disease training, staff shortage, communication challenges: documentation problems, limited awareness of chronic kidney disease both health providers and patients, respectively. Stock out and service interruption were diagnostic challenge. High out-of pocket costs, and insufficient budget: absence of chronic kidney disease specific guideline, weak referral coordination, were financial and governance challenges. Conclusion: Chronic kidney disease (CKD) screening and referral are hindered by service delivery, health information system, diagnostic, health work force, finance and administrative barriers. This cause decreased early detection, obstacle for continuity of care. Therefore, if there is no solution, chronic kidney disease will remain underdiagnosed and poorly managed at the primary care level. Recommendation: Chronic kidney disease-specific guidelines should be developed, staff training should be increased, diagnostic services, and health information systems should be improved. Dedicated financing and stronger referral coordination are essential to ensure equitable access and continuity of chronic kidney disease careen: Chronic kidney diseaseScreeningReferralHealth system barriersPrimary health careEthiopia.Thesis