title: 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.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  Integrated CKD Care can delay CKD progression in resource-limited settings.
  
  
  
  ( NCT01978951 ). Prospectively registered as of December 8, 2012.
authors.affiliation: Bhumirajanagarindra Kidney Institute, Phaya Thai Rd., Ratchathewi District, Bangkok, 10400, Thailand. teerayut065@yahoo.com.
authors.forename: Teerayuth
authors.identifier: 0000-0003-1708-8240
authors.initials: T
authors.lastname: Jiamjariyapon
authors.affiliation: Division of Nephrology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Atiporn
authors.initials: A
authors.lastname: Ingsathit
authors.affiliation: 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.
authors.forename: Krit
authors.initials: K
authors.lastname: Pongpirul
authors.affiliation: Bhumirajanagarindra Kidney Institute, Phaya Thai Rd., Ratchathewi District, Bangkok, 10400, Thailand.
authors.forename: Kotcharat
authors.initials: K
authors.lastname: Vipattawat
authors.affiliation: Bhumirajanagarindra Kidney Institute, Phaya Thai Rd., Ratchathewi District, Bangkok, 10400, Thailand.
authors.forename: Suphattra
authors.initials: S
authors.lastname: Kanchanakorn
authors.affiliation: Bhumirajanagarindra Kidney Institute, Phaya Thai Rd., Ratchathewi District, Bangkok, 10400, Thailand.
authors.forename: Akhathai
authors.initials: A
authors.lastname: Saetie
authors.affiliation: Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Duangjit
authors.initials: D
authors.lastname: Kanistanon
authors.affiliation: Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Patimaporn
authors.initials: P
authors.lastname: Wongprompitak
authors.affiliation: Khamphaeng Phet Provincial Health Office, Ministry of Public Health, Khamphaeng Phet, Thailand.
authors.forename: Vinai
authors.initials: V
authors.lastname: Leesmidt
authors.affiliation: Khamphaeng Phet Provincial Health Office, Ministry of Public Health, Khamphaeng Phet, Thailand.
authors.forename: Watcharapong
authors.initials: W
authors.lastname: Watcharasaksilp
authors.affiliation: Department of Biostatistical Science, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Chandraker
authors.affiliation: Division of Nephrology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Kriang
authors.initials: K
authors.lastname: Tungsanga
mesh_terms: D000368:Aged; D003150:Community Health Workers; D003695:Delivery of Health Care / Q000379:methods*; D019468:Disease Management; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006792:House Calls; D006801:Humans; D008297:Male; D008875:Middle Aged; D009398:Nephrology; D010348:Patient Care Team; D010349:Patient Compliance; D010353:Patient Education as Topic; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000378:metabolism / Q000628:therapy*; D012424:Rural Population; D012720:Severity of Illness Index; D013785:Thailand
keywords: Chronic Kidney Disease; Integrated CKD care; Village health volunteers