Effectiveness of Integrated Care On Delaying Chronic Kidney Disease Progression In Rural Communities of Thailand (ESCORT-2) trials.

AIM: We conducted a prospective cohort study to evaluate the effectiveness of an integrated care model on delaying chronic kidney disease (CKD) progression in routine clinical practice in rural primary care setting.

METHODS: After enrollment, patients with stage 3-4 CKD patients from 5 district hospitals in a northern province of Thailand (400 kilometers from Bangkok) received integrated care comprising hospital multidisciplinary care and home visits by community care teams. Clinical characteristics and biochemical data were collected at baseline and every 3-month interval thereafter for 36 months. The primary outcome was the rate of estimated glomerular filtration rate (eGFR) decline.

RESULTS: Nine hundred and fourteen stage -3 and -4 CKD patients were enrolled. The mean age of our cohort was 62 years. Diabetic kidney disease [DKD] was the main cause of CKD (53%) whereas hypertension was the most common co-morbidity (92%). The mean rate of eGFR decline was - 0.92 ml/min/1.73m2/year. The rate of eGFR decline among patients with DKD was about 3 times faster than patients without DKD. Patients with higher blood pressure, metabolic acidosis, proteinuria, or anemia had a faster rate of eGFR decline.

CONCLUSION: This integrated care model at the community level was effective in delaying CKD progression in routine clinical practice situation.