Open Access Study protocol

Effectiveness of integrated care on delaying chronic kidney disease progression in rural communities of Thailand (ESCORT study): rationale and design of the study [NCT01978951]

Teerayuth Jiamjariyaporn1*, Atiporn Ingsathit2, Kriang Tungsanga3, Chatri Banchuin1, Kotcharat Vipattawat1, Suphattra Kanchanakorn1, Vinai Leesmidt4, Watcharapong Watcharasaksilp5, Akhathai Saetie1, Chanida Pachotikarn6, Sunard Taechangam6, Tanyarat Teerapornlertratt1, Teerachai Chantarojsiri1 and Visith Sitprija7

Author Affiliations

1 Bhumirajanagarindra Kidney Institute, Bangkok, Thailand

2 Division of Nephrology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

3 Division of Nephrology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

4 Khlong Khlung District Hospital, Ministry of Public Health, Khamphaeng Phet, Thailand

5 Saithong Wattana District Hospital, Ministry of Public Health, Khamphaeng Phet, Thailand

6 Institute of Nutrition, Mahidol University, Bangkok, Nakhon Pathom Province, Thailand

7 Queen Saovabha Memorial Institute, Bangkok, Thailand

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BMC Nephrology 2014, 15:99  doi:10.1186/1471-2369-15-99

Published: 25 June 2014

Abstract

Background

In developing countries, accessibility to specialists, and physician to patient contact time is limited. In Thailand, A unique community health service is provided by subdistrict health care officers and Village Health Volunteers (VHVs). If the personnel were trained on proper chronic kidney disease (CKD) care, CKD progression would be delayed.

Methods/Design

We conducted a community-based, cluster randomized controlled trial at Kamphaeng Phet Province, located about 400 kilometers north of Bangkok. Two out of eleven districts of the province were randomly selected. Approximatly 500 stage 3–4 CKD patients from 2 districts were enrolled. Patients in both groups will be treated with standard guidelines. The patients in intervention group were provided the additional treatments by multidisciplinary team in conjunction with community CKD care network (subdistrict health care officers and VHVs) which will provide group counseling during each hospital visit and quarterly home visits to monitor dietary protein and sodium intake, blood pressure measurement and drug compliance. Duration of the study is 2 years. The primary outcome is the difference of rate of eGFR decline. The secondary outcomes are laboratory parameters and incidence of clinical endpoints such as mortality rate and cardiovascular events, end-stage renal disease (ESRD), etc.

Discussion

Insights of this study may set forth a new standard of community-based CKD care.

Trial registration

NCT01978951.

Keywords:
Chronic kidney disease; Integrated CKD care program; Village health volunteers