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Aim: We conducted a prospective cohort study to evaluate the effectiveness of an integrated care model on delaying chronic kidney disease (CKD) progression in routine clinical practice in rural primary care setting. Methods: After enrolment, patients with stages 3 to 4 CKD patients from five district hospitals in a northern province of Thailand (400 km from Bangkok) received integrated care comprising hospital multidisciplinary care and home visits by community care teams. Clinical characteristics and biochemical data were collected at baseline and every 3‐month interval thereafter for 36 months. The primary outcome was the rate of estimated glomerular filtration rate (eGFR) decline. Results: Nine hundred and fourteen stage −3 and − 4 CKD patients were enrolled. The mean age of our cohort was 62 years. Diabetic kidney disease (DKD) was the main cause of CKD (53%) whereas hypertension was the most common co‐morbidity (92%). The mean rate of eGFR decline was −0.92 mL/min/1.73 m2/year. The rate of eGFR decline among patients with DKD was about three times faster than patients without DKD. Patients with higher blood pressure, metabolic acidosis, proteinuria or anaemia had a faster rate of eGFR decline. Conclusion: This integrated care model at the community level was effective in delaying CKD progression in routine clinical practice situation. SUMMARY AT A GLANCE: This report of a prospective cohort study shows the effectiveness of an integrated care model on delaying CKD progression in a Thai rural primary care setting. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) affects around 10% of the global population and has been estimated to affect around 50% of individuals with type 2 diabetes and 50% of those with heart failure. The guideline-recommended approach is to manage with disease-modifying therapies, but real-world data suggest that prescribing rates do not reflect this in practice., Objective: To develop a cross-specialty consensus on optimal management of the patient with CKD using a modified Delphi method., Design: An international steering group of experts specialising in internal medicine, endocrinology/diabetology, nephrology and primary care medicine developed 42 statements on aspects of CKD management including identification and screening, risk factors, holistic management, guidelines, cross-specialty alignment and education. Consensus was determined by agreement using an online survey., Participants: The survey was distributed to cardiologists, nephrologists, endocrinologists and primary care physicians across 11 countries., Main Outcomes and Measures: The threshold for consensus agreement was established a priori by the steering group at 75%. Stopping criteria were defined as a target of 25 responses from each country (N=275), and a 4-week survey period., Results: 274 responses were received in December 2022, 25 responses from Argentina, Australia, Brazil, Guatemala, Mexico, Singapore, South Korea, Taiwan, Thailand, Turkey and 24 responses from Egypt. 53 responses were received from cardiologists, 52 from nephrologists, 55 from endocrinologists and 114 from primary care physicians. 37 statements attained very high agreement (≥90%) and 5 attained high agreement (≥75% and <90%). Strong alignment between roles was seen across the statements, and different levels of experience (2-5 years or 5+ years), some variation was observed between countries., Conclusions: There is a high degree of consensus regarding aspects of CKD management among healthcare professionals from 11 countries. Based on these strong levels of agreement, the steering group derived 12 key recommendations focused on diagnosis and management of CKD., Competing Interests: Competing interests: MA has received payment honoraria for lectures, presentations, speaker bureaus, publication writing or educational events from: Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Menarini, MSD, Novo Nordisk, Sandoz and Sanofi. MA has also participated in a Data Safety Monitoring Board or Advisory Boards for: AstraZeneca, Bayer, Boehringer Ingelheim and Novo Nordisk. MCB has worked as speaker for: Aché, AstraZeneca, Bayer, Boehringer-Ingelheim, Novo-Nordisk, and Servier. JC has consulted for, or been on advisory boards for: AstraZeneca, ATC, Bayer, GSK, Nitto Denko and Pfizer. JC has been a speaker for: Abbott, AstraZeneca, Bayer and Boehringer Ingelheim. JC has been on Steering Committees or Data Safety Monitoring Boards for: AstraZeneca, Boehringer Ingelheim and Novartis, and has received scientific grant funding from AstraZeneca, ATC, and Nitto Denko. Y-JL has been a speaker and Advisory Board member for: AstraZeneca Taiwan. MM was the International Society for Nephrology Deputy Chair for Latin America and Caribbean (2019–2023) and is currently the on the council for the International Society for Peritoneal Disease (2022–2024). MM has been a consultant for: AstraZeneca, Bayer, and Boehringer Ingelheim, and provided expert testimony for: AstraZeneca, Bayer and Boehringer Ingelheim. MM has received grants from or has pending grants with: AstraZeneca*, Bayer*, Boehringer, Renal Research Institute* and Tricida*. MM has received travel grants from: AstraZeneca and Medcom. GJRD has been a speaker or Advisory Board member for Astra Zeneca, Boehringer Ingelheim, Bayer, Fresenius and Medtronic. SC has received honoraria as a speaker or advisory board member from AstraZeneca, Boehringer Ingelheim, Daewon, Daewoong, Eli Lilly, Korea Pharma, Myoung Poom Medical, Otsuka, Sanofi-Aventis and Yuhan. CP has been a speaker or participated in advisory boards for Astra Zeneca, Boehringer Ingelheim, Eli Lilly, GlaxoSmithKline, Otsuka, Vifor-CSL. SHA-K, VSP and TT declare no conflict of interest in regard to this study., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)