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

BMC Nephrology

Research Article

Teerayuth Jiamjariyapon¹  Suphattra Kanchanakorn¹  Akhathai Saetie¹  Kotcharat Vipattawat¹  Wei Wang²  Patimaporn Wongprompitak³  Duangjit Kanistanon³  Krit Pongpirul⁴  Kriang Tungsanga⁵  Atiporn Ingsathit⁶  Watcharapong Watcharasaksilp⁷  Vinai Leesmidt⁷  Anil K. Chandraker⁸ 

[1] Bhumirajanagarindra Kidney Institute, Phaya Thai Rd., Ratchathewi District, 10400, Bangkok, Thailand;Department of Biostatistical Science, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA;Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand;Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;Division of Nephrology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;Division of Nephrology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;Khamphaeng Phet Provincial Health Office, Ministry of Public Health, Khamphaeng Phet, Thailand;Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA;

关键词: Chronic Kidney Disease;    Integrated CKD care;    Village health volunteers;   

DOI  :  10.1186/s12882-016-0414-4

 received in 2015-12-04, accepted in 2016-12-07,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundIn 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.MethodsWe 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.ResultsThe 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).ConclusionIntegrated CKD Care can delay CKD progression in resource-limited settings.Trial registration(NCT01978951). Prospectively registered as of December 8, 2012.

【 授权许可】

CC BY   
© The Author(s). 2017