Table 2

Regional and local CKD care models

(A) With interventions assessed in randomised groups
StudyCountryPopulationCare modelIntervention componentsMode of deliveryEvaluation methodsOutcomesRisk of bias
ScreeningDecision supportPatient education
Cortés-Sanabria et al 22 Mexico94 patients (with diabetes and albuminuria), 40 PCPs6-month education programme for PCPs on diabetic nephropathy+PCPsPilot RCTCompetency improved in 19/21 trained physicians. In patients (n=43) treated by trained physicians albuminuria declined (vs increases of 142–289 mg/g) and eGFR remained stable (vs declines of 16–32 mL/min in prospectively followed patients) at 12 monthsMedium
Jiamjariyapon et al 20 Thailand442 patients with CKD stages 3 and 4Combined MDC and community health workers (providing home visits for risk factor monitoring and medication adherence)++CHWRCTIn MDC patients (n=234), eGFR was within 0.1 mL/min of baseline (vs decline by 2.0 mL/min in control group); HR for composite endpoint of ESRD, 50% increase in serum Cr and CV events was 0.59 (0.37–0.96) in MDC patients over 24 monthsMedium
Jafar et al 13 Pakistan1271 patients with hypertension, 12 communities2×2 factorial design for family-based education on self- management+PCP education on management of blood pressure++PCPs, CHWCluster RCTMild increase in albuminuria in intervention (n=644) and control groups; eGFR stable (within 0.3 mL/min of baseline) in intervention versus declining by 4 mL/min in control groups after 84 monthsLow
Tang et al 21 China90 patients with early-stage CKDExercise education with in-home aerobic programme prescription+Physical therapistsRCTIn patients receiving exercise guidance (n=42), improvements in 6 min walk test and health-related quality (measured by SF-12) versus control group at 3 monthsHigh