Effectiveness of Integrated Care on Delaying Progression of stage 3-4 Chronic Kidney Disease in Rural Communities of Thailand (ESCORT study): a cluster randomized controlled trial

Teerayuth Jiamjariyapon, Atiporn Ingsathit, Krit Pongpirul, Kotcharat Vipattawat, Suphattra Kanchanakorn, Akhathai Saetie, Duangjit Kanistanon, Patimaporn Wongprompitak, Vinai Leesmidt, Watcharapong Watcharasaksilp, Wei Wang, Anil K Chandraker, Kriang Tungsanga, Teerayuth Jiamjariyapon, Atiporn Ingsathit, Krit Pongpirul, Kotcharat Vipattawat, Suphattra Kanchanakorn, Akhathai Saetie, Duangjit Kanistanon, Patimaporn Wongprompitak, Vinai Leesmidt, Watcharapong Watcharasaksilp, Wei Wang, Anil K Chandraker, Kriang Tungsanga

Abstract

Background: In developing countries, renal specialists are scarce and physician-to-patient contact time is limited. While conventional hospital-based, physician-oriented approach has been the main focus of chronic kidney disease (CKD) care, a comprehensive multidisciplinary health care program (Integrated CKD Care) has been introduced as an alternate intervention to delay CKD progression in a community population. The main objective is to assess effectiveness of Integrated CKD Care in delaying CKD progression.

Methods: We carried out a community-based, cluster randomized controlled trial. Four hundred forty-two stage 3-4 CKD patients were enrolled. In addition to the standard treatments provided to both groups, the patients in the intervention group also received "Integrated CKD Care". This was delivered by a multidisciplinary team of hospital staff in conjunction with a community CKD care network (subdistrict healthcare officers and village health volunteers) to provide group counseling during each hospital visit and quarterly home visits to monitor compliance with the treatment. Duration of the study was 2 years. The primary outcome was difference of mean eGFR between the intervention and the control groups over the study period.

Results: The mean difference of eGFR over time in the intervention group was significantly lower than the control group by 2.74 ml/min/1.73 m2 (95%CI 0.60-4.50, p = 0.009). Seventy composite clinical endpoints were reported during the study period with significantly different incidences between the control and the intervention groups (119.1 versus 69.4 per 1000 person-years; hazard ratio (HR) 0.59, 95% CI 0.4-0.9, p = 0.03).

Conclusion: Integrated CKD Care can delay CKD progression in resource-limited settings.

Trial registration: ( NCT01978951 ). Prospectively registered as of December 8, 2012.

Keywords: Chronic Kidney Disease; Integrated CKD care; Village health volunteers.

Figures

Fig. 1
Fig. 1
Flow chart of participants. Abbreviation: ESRD, End-stage renal disease
Fig. 2
Fig. 2
Changes in eGFR during the follow-up period (Primary outcome). GEE analyses were used to determine mean differences over time of estimated Glomerular Filtration Rate (eGFR) between intervention group and control group during the follow-up period
Fig. 3
Fig. 3
Changes in clinical and laboratory parameters during the follow-up period. GEE analyses were used to determine mean differences over time of clinical outcomes and laboratory parameters between the two groups. Change in systolic BP (a), diastolic BP (b), hemoglobin A1C (c), serum bicarbonate (d), serum triglyceride (e), urine protein-creatinine ratio (f), 24-h urine normalized protein nitrogen appearance (g), 24-h urine sodium (h) between intervention group and control group during the follow-up period

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Source: PubMed

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