A Study for Delaying Kidney Deterioration of Chronic Kidney Disease Patients of Khlongkhlung Hospital: From Research to Practice

Abstract

The objectives of this study were to assess the outcomes of the implementation of chronic kidney disease (CKD) clinic of Khlong Khlung Hospital after becoming a routine service since 2013; and to identify factors associated with the change of CKD patients to stage 5 despite being taken care by the effective services. Study population were patients with CKD stages 3 and 4 who attended the Khlongkhlung Hospital kidney clinic during 2013-2015, of whom the annual total number was 1,270, 1,444 and 1,752 cases, respectively. There were 954 cases who were followed up continuously for 3 years. There were 6 services provided by the kidney clinic which included CKD screening, service system setting, setting of service provision by a multidisciplinary team, laboratory schedule setting and data recording. The assessment waas performed by analyzing 18 essential variables including age, sex, Scr, eGFR, FBS, HbA1c, cholesterol, TG, LDL, uic acid, Hct, Hb, SBP, DBP, BMI, waist and amount of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-receptor blockers (ARBs). Data were analyzed by using both descriptive and analytical statistics including repeated ANOVA logistic regression for assessing the outcomes. It was found that the kidney clinic of Khlong Khlung Hospital could significantly reduce the deterioration of renal function, resulting in the slow decline of eGFR (less than 4 ml/min/1.73m² ) after 2 years. In addition, the patients were able to control their blood sugar and lipid more effectively despite the severity of their blood pressure and BMI. The stability of stages 3 and 4 exceeded 70%. The percent-age of patients with rapid eGFR declination (greater than 1 ml/min/1.73m² /month) had a tendency to slow down. There were 5 factors significantly influencing the renal deterioration to become CKD stage 5: age, cholesterol, urine microalbumin, urine protein and ARBs treatment (p<0.05).