Abstract
BackgroundThe incidence of chronic kidney disease (CKD) is high in the Northeast Thailand compared to other parts of the country. Therefore, a broad program applying all levels of care is inevitable. This paper describes the results of the first year trial of the Chronic Kidney Disease Prevention in the Northeast Thailand (CKDNET), a quality improvement project collaboratively established to curb CKD.MethodsWe have covered general population, high risk persons and all stages of CKD patients with expansive strategies such as early screening, effective CKD registry, prevention and CKD comprehensive care models including cost effectiveness analysis.ResultsThe preliminary results from CKD screening in general population of two rural sub-districts show that 26.8% of the screened population has CKD and 28.9% of CKD patients are of unknown etiology. We have established the CKD registry that has enlisted a total of 10.4 million individuals till date, of which 0.13 million are confirmed to have CKD. Pamphlets, posters, brochures and other media of 94 different types in the total number of 478,450 has been distributed for CKD education and awareness at the community level. A CKD guideline that suits for local situation has been formulated to deal the problem effectively and improve care. Moreover, our multidisciplinary intervention and self-management supports were effective in improving glomerular filtration rate (49.57 versus 46.23 ml/min/1.73 m2; p < 0.05), blood pressure (129.6/76.1 versus 135.8/83.6 mmHg) and quality of life of CKD patients included in the program compared to those of the patients under conventional care. The cost effectiveness analysis revealed that lifetime cost for the comprehensive health services under the CKDNET program was 486,898 Baht compared to that of the usual care of 479,386 Baht, resulting in an incremental-cost effectiveness ratio of 18,702 Baht per quality-adjusted life years gained.ConclusionCKDNET, a quality improvement project of the holistic approach is currently applying to the population in the Northeast Thailand which will facilitate curtailing of CKD burden in the region.
Highlights
The incidence of chronic kidney disease (CKD) is high in the Northeast Thailand compared to other parts of the country
Our initial data revealed that the prevalence of CKD in these study areas was 26.8% of the screened population which was higher than that reported previously [9]
CKD registry Currently, our CKD surveillance system shows that 225 hospitals are in the list and most of them are located in the Northeast Thailand
Summary
The incidence of chronic kidney disease (CKD) is high in the Northeast Thailand compared to other parts of the country. In 2009, the Thai- Screening and Early Evaluation of Kidney Disease (SEEK) study group reported that the prevalence of CKD in Thailand is 17.5% with stages I, II, III and IV 3.3, 5.6, 7.5 and 1.1%, respectively [9]. Awareness of the CKD among the Thai population is extremely low [9] This is vital because earlier detection of CKD allows timely intervention, potentially slower the progression of disease, and decrease mortality [12, 13]. Based on the high prevalence of CKD, the policy to mitigate CKD burden was developed in Thailand by setting up CKD clinics in various hospitals. We have explored and found the barriers of CKD reduction including;- (i) lack of national registry of CKD, (ii) insufficient number of trained case-manager nurses, (iii) unawareness of risk factors or unable to change behavior of people, (iv) no early CKD detection measures and (v) inadequate supports from society, community and policy makers
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