Regional and local CKD care models
| (A) With interventions assessed in randomised groups | ||||||||||
| Study | Country | Population | Care model | Intervention components | Mode of delivery | Evaluation methods | Outcomes | Risk of bias | ||
| Screening | Decision support | Patient education | ||||||||
| Cortés-Sanabria et al 22 | Mexico | 94 patients (with diabetes and albuminuria), 40 PCPs | 6-month education programme for PCPs on diabetic nephropathy | − | + | − | PCPs | Pilot RCT | Competency 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 months | Medium |
| Jiamjariyapon et al 20 | Thailand | 442 patients with CKD stages 3 and 4 | Combined MDC and community health workers (providing home visits for risk factor monitoring and medication adherence) | − | + | + | CHW | RCT | In 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 months | Medium |
| Jafar et al 13 | Pakistan | 1271 patients with hypertension, 12 communities | 2×2 factorial design for family-based education on self- management+PCP education on management of blood pressure | − | + | + | PCPs, CHW | Cluster RCT | Mild 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 months | Low |
| Tang et al 21 | China | 90 patients with early-stage CKD | Exercise education with in-home aerobic programme prescription | − | − | + | Physical therapists | RCT | In 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 months | High |