Chronic Kidney Diseases
Conditions
Keywords
chronic kidney disease, clinical trial, primary care, kidney function
Brief summary
Background: Chronic kidney disease (CKD) is a major public health threat associated with significant morbidity, high mortality, and reduced quality of life. However, empirical evidence is limited on strategies to enhance the effectiveness of care for CKD. The objective of the trial is to evaluate the effectiveness and cost-effectiveness of multicomponent primary care strategies in preserving kidney function among patients with CKD at primary care clinics in Singapore. Methods: A pragmatic, randomized controlled trial, in 4 socioeconomically diverse primary care clinics (polyclinics) in Singapore over 3 years. A total of 896 participants with CKD Stage 3 or worse aged ≥40 and \<80 years will be enrolled, with 224 from each polyclinic. Participants enrolled in each polyclinic will be randomly allocated to the intervention or usual care group in a 1:1 ratio. Intervention includes four components 1) training nurses as health coaches for motivational conversation and CKD specific lifestyle counseling on diet and exercise, using hybrid follow-up approach of in-person, telephone, and secure WhatsApp video meetings; 2)Training physicians in algorithm-based standardized management of CKD and hybrid care delivery;3) subsidy on sodium-glucose transport protein-2 inhibitors (SGLT-2i) for CKD; and 4) regular CKD case review meetings. Patients in the usual care arm will be treated by physicians and nurses who and are not trained in SKOPE treatment algorithms. Study outcomes: The primary outcome will be the eGFR total slope from randomization to final follow-up at 36 months. secondary effectiveness outcomes will be 1) Change in CVD risk score as measured by The Million Hearts Longitudinal ASCVD Risk Assessment score 2) Change in CKD quality of life measured by KDQOL-36TM
Interventions
Intervention includes four components 1) training nurses as health coaches for motivational conversation and CKD specific lifestyle counseling on diet and exercise, using hybrid follow-up approach of in-person, telephone, and secure video sessions; 2)Training physicians in algorithm-based standardized management of CKD and hybrid care delivery;3) subsidy on sodium-glucose transport protein-2 inhibitors (SGLT-2i) for CKD; and 4) regular CKD case review meetings.
Sponsors
Duke-NUS Graduate Medical School
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
40 Years to 79 Years
Healthy volunteers
No
Inclusion criteria
4.3 Inclusion Criteria * Patients with CKD Stage 3 or Stage 4 defined as persistent reduction in Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula eGFR ≥15 and \< 60 ml/min/1.73m2 for at least 3 months based on two eGFR readings at least 3 months apart and the last eGFR should be measured at least 3 months ago. * Receiving care at the polyclinics in Singapore for at least one year at the time of recruitment * Age \>=40 and \<80 years * Singaporean or permanent resident 4.4
Exclusion criteria
* On kidney replacement therapy * Pregnancy or breastfeeding * Known terminal illness * Recent hospitalization during last 3 months * History of leg or foot ulcers, severe mental illness, prior kidney transplant * Inability to provide informed consent
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| the eGFR | from randomization to final follow-up at 36 months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mean change in CVD risk score | at 12, 24, and 36 months from the baseline | measured by The Million Hearts Longitudinal atherosclerotic cardiovascular disease(ASCVD) Risk Assessment score:not assessed via a scale. Results are given as a percent (%) on a scale of less than 1% to 99.99%. A higher score indicates a higher risk |
| Mean change in CKD quality of life | at 12, 24, and 36 months from the baseline | Assessed by Kidney Disease Quality of Life 36-item short form survey(KDQOL-36TM), score ranges from 0 to 100, higher scores dente better quality of life |
Other
| Measure | Time frame | Description |
|---|---|---|
| Incident ACR >300 mg/g; | from randomization to final follow-up at 36 months | — |
| Incident dialysis | from randomization to final follow-up at 36 months | — |
| Rate of MACE (composite of total death, myocardial infarction, coronary revascularization, stroke, and hospitalization because of heart failure | from randomization to final follow-up at 36 months | — |
| Mean change in kidney failure risk equation ( KFRE) score | from randomization to final follow-up at 36 months | The score is based on an equation not on a scale,Results are given as a percent (%) on a scale of less than 1% to 99.99%. A higher score indicates a higher risk |
| Proportion of subjects who experienced albuminuria defined as ACR >30 mg/g | from randomization to final follow-up at 36 months | defined as ACR \>30 mg/g |
| Rate of All-cause mortality | from randomization to final follow-up at 36 months | — |
| Rate of CVD deaths | from randomization to final follow-up at 36 months | — |
| Rate of hospital admission due to CHD, heart failure, or stroke | from randomization to final follow-up at 36 months | — |
| Mean change in Dietary score | from randomization to final follow-up at 36 months | Not based on a scale, higher score indicates better outcome |
| Incident eGFR <30 ml/min/1.73m2 | from randomization to final follow-up at 36 months | — |
| Mean change in BMI | from randomization to final follow-up at 36 months | — |
| Mean change in adherence to antihypertensive | from randomization to final follow-up at 36 months | — |
| Mean change in adherence to glucose-lowering medication | from randomization to final follow-up at 36 months | — |
| Mean change from baseline in therapeutic intensity score of antihypertensive medication (all and class specific) therapeutic intensity score (summary measure that accounts for the number of medications and the relative doses a patient received) | from randomization to final follow-up at 36 months | summary measure that accounts for the number of medications and the relative doses a patient received. Higher scores indicate higher dose. |
| Mean change in Framingham risk score | from randomization to final follow-up at 36 months | based on an equation, Results are given as a percent (%) on a scale of less than 1% to 99.99%. A higher score indicates a higher risk |
| Proportion of subjects with at least 40% decline in baseline eGFR or kidney replacement therapy ( KRT) with mortality | from randomization to final follow-up at 36 months | — |
| b) Proportion of subjects with at least 40% decline in baseline eGFR or KRT without mortality | from randomization to final follow-up at 36 months | — |
| c) Proportion of subjects with at least 50% decline in baseline eGFR or KRT with mortality | from randomization to final follow-up at 36 months | — |
| d) Proportion of subjects with at least 50% decline in baseline eGFR or KRT without mortality | from randomization to final follow-up at 36 months | — |
| Mean change in level of physical activity | from randomization to final follow-up at 36 months | International Physical Activity Questionnaire (PHAQ): there is no range, higher scores denote higher levels of physical activities |
| Incident eGFR <45 ml/min/1.73m2; | from randomization to final follow-up at 36 months | — |
| Incident eGFR <15 ml/min/1.73m2; | from randomization to final follow-up at 36 months | — |
Countries
Singapore
Contacts
Primary ContactTazeen H. Jafar, MBBS, MPH, FASN
Outcome results
None listed