Impact of the Chronic Kidney Disease Clinic Policy on eGFR Decline among CKD Patients in a Province of Northeast Thailand: An Interrupted Time Series Analysis
Piyalak Pudeesamai¹, Sirirat Anutrakulchai², Pongdech Sarakarn¹,³
Affiliation : ¹ Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kean University, Khon Kean, Thailand; ² Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kean, Thailand; ³ ASEAN Cancer Epidemiology and Prevention Research Group, Khon Kaen University, Khon Kean, Thailand
Background: Chronic kidney disease (CKD) poses a growing global health concern, particularly in low- and middle-income countries. In Thailand, CKD affects 4.6% to 17.5% of the population, with diabetic nephropathy and hypertension being the primary causes of end-stage renal disease (ESRD). To mitigate this, the Ministry of Public Health introduced CKD clinic policies in 2016 to slow progression in stages 1 to 4. The ESCORT-2 study demonstrated the effectiveness of integrated care, prompting nationwide adoption. The present study assessed the policy impact using 12 clinical performance indicators.
Materials and Methods: Data from CKD stage 3 to 4 patients were retrieved from Roi Et Province’s Health Data Center between January 2014 and December 2021. Interrupted time series (ITS) analysis evaluated performance trends before and after policy implementation, stratified by hospital level.
Results: Following policy implementation, significant improvements were observed in four key indicators, 1) the proportion of CKD patients receiving angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) increased from 43.46% by 7.95% (95% CI 4.41 to 11.49), 2) statin use rose from 39.78% by 3.51% (95% CI 0.063 to 6.95), 3) the percentage of patients with estimated glomerular filtration rate (eGFR) decline to less than 5 mL/minute/1.73 m²/year improved from 55.31% by 13.93% (95% CI 0.19 to 27.67), 4) urine protein to creatinine ratio (UPCR) testing increased from 2.10% by 9.64% (95% CI 0.31 to 18.98). Post-policy linear trend analysis also showed modest increases in ACEi/ARB use, potassium monitoring, statin prescription, and intact parathyroid hormone (iPTH) testing.
Conclusion: The implementation of the kidney disease clinic policy has positively influenced the care of patients with chronic kidney disease. Continuing of this policy would benefit patients with chronic kidney disease.
Received 20 December 2024 | Revised 25 April 2025 | Accepted 28 April 2025
DOI: 10.35755/jmedassocthai.2025.6.448-456-02156
Keywords : Chronic kidney disease; CKD clinic; Interrupted time series
