(B) With convenience sampling and/or before-after design | ||||||||||
Study | Country | Population | Care model | Intervention components | Mode of delivery | Evaluation methods | Outcomes | Methodological quality | ||
Screening | Decision support | Patient education | ||||||||
Barahimi et al 24 | Iran | 131 patients | Self-learning module discussing kidney disease and its complications (with oral presentation held at start) | − | − | + | Patients | Prospective comparison | In patients electing to undertake e-learning (n=39), eGFR remained stable (within 7 mL/min) versus decline in control group at 6 months. E-learning remained an important predictor of higher eGFR after adjustments for significant differences in two groups (age, education, mean arterial pressure). | Low |
Cueto-Manzano et al 25 | Mexico | 96 patients with diabetes and early-stage CKD, two clinics | Patient and PCP education on CKD; formation of patient peer groups; MDC | − | + | + | PCP; nurses | Prospective comparison | In patients of MDC (n=39), albuminuria dropped (vs usual care, where albuminuria did not change) over 6 months. No differences in eGFR | Low |
Fogazzi et al 26 | Benin and Togo | Two hospitals | Capacity building for CKD care at hospital level | − | + | − | Lab tech | Before-after | Improved laboratory capacity to identify kidney disease | Low |
Garcia-Garcia et al 14 | Mexico | 353 patients with CKD stages 3 and 4 | Nursing-led MDC with equal time allotted to nurses, physicians, social workers and dietitians | − | + | + | Nurses | Before-after | In patients of MDC (n=353), % with BP control doubled, mean HbA1c dropped, use of ARB increased over median 14 months. Proportion with proteinuria did not change. eGFR declined 3.8 mL/min in patients with and stable in patients without diabetes, respectively. | Medium |
Katz et al 23 | South Africa | 871 patients in primary care clinics, 16 clinics | Screening and treatment guidelines with referral pathway | + | + | − | PCPs; CHW | Case–control | Proportion of patients with uncontrolled BP dropped from 85% to 70% in active clinics (vs no change in control clinics); 98% use of ACEi in persons with diabetes and albuminuria at 3 months | Low |
Mani27 | India | 25 000 rural residents | Community-based screening with simplified management protocols | + | + | − | CHW | Case–control | eGFR<80 mL/min in 0.9% of residents of intervention areas versus in 1.4% of residents of areas receiving standard care (no adjustment for baseline demographics) in cross section | Low |
Tungsanga et al 28 | Thailand | 17 patients with stage 4 CKD, one clinic | MDC and dietary intervention | − | + | + | Nephrologists; dietitian | Prospective follow-up | In the described group (n=17), mean 24 hours urine declined slightly (from 1 to 0.8 g), mean eGFR within 0.6 mL/min of baseline over 48 months. | Low |
Zhang et al 29 | China | 300 patients, one clinic | MDC, including dietitian and nursing-led education | − | + | + | Nephrologists; nurses | Before-after | Unable to establish feasibility due to high patient dropout with limited follow-up | Low |
ACEi, ACE inhibitors; ARB, angiotensin II receptor blockers; HR: hazard ratio; BP, blood pressure; CHW, community health worker; CKD, chronic kidney disease; Cr, creatinine; CV, cardiovascular; eGFR, estimated glomerular filtration rate (in mL/min/1.73 m2); ESRD, end-stage renal disease; MDC, multidisciplinary care; PCP, primary care provider; RCT, randomised controlled trial; SF-12, 12-Item Short Form Health Survey.