Experience with prevention programs in Thailand

Thailand is a developing country with a population of 62 million. It is estimated to have 1.6 million stage 3 or higher chronic kidney disease (CKD) patients. With limited funding for dialysis support, prevention of renal disease progression is mandatory and urgently needed.

The Nephrology Society of Thailand has conducted a survey among Thai nephrologists. The data were analyzed, and a multidisciplinary team approach was introduced to make patients more informed about CKD and more compliant with dietary prescription.

The survey showed that the majority of Thai nephrologists know about CKD guidelines. They regularly employed several modes of drug therapy and appropriate target of blood pressure control. However, only 38% and 5% of nephrologists used multidisciplinary team approach and knew how to calculate dietary protein intake, respectively, in CKD patients. To facilitate dietary counseling and care team approach, we invented several dietary record forms (in Thai), Thai food exchange list, 7-day low-protein Thai food menu, and several patient education guidebooks. We also set 1-day lecture tour courses for physicians, nurses, and dietitians in various parts of the country. At our own institute, we followed 17 CKD patients for 4 years: the creatinine clearance (CCr) and glomerular filtration rate (GFR) were 37.5 +/- 5.5 and 24.4 +/- 4.3 mL/min, respectively, at the beginning, and were 35.7 +/- 4.5 and 25.0 +/- 3.5 mL/min, respectively, 4 years thereafter. The rates of Ccr and GFR decline were -0.5 +/- 0.9 mL/min/year and 0.2 +/- 0.6 mL/min/year, respectively.

A combination of appropriate drug and dietary therapy by employing a multidisciplinary team approach can effectively delay renal disease progression.