CKD is a global endemic disease with increased comorbidities and mortality. The prevalence and the incidence of the end-stage renal disease (ESRD) are extremely high in Taiwan. The prevalence of CKD remains high; however, the awareness remains low. Screening of unique risk factor and early diagnosis of CKD can improve outcome. Furthermore, data of renal education deep into the community remains limited. The aims of this study are: 1. Explore risk factors associated with CKD in the community 2. Establish multidisciplinary care model in the community 3. Investigate mechanistic mediators for CKD and multidisciplinary education approached in behavioral , physiological, immune and metabolomics aspects 4. Provide bio-specimen repository for future study
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
PREVENTION
Masking
NONE
Enrollment
10,000
multidisciplinary CKD care involving case management nurse, dietitian, social worker, pharmacists.
Department of Nephrology, Chang Gung Memorial Hospital
Keelung, Taiwan
RECRUITINGeGFR < 60 mL/min
change of renal function between groups
Time frame: through study completion, every 1 year
albuminuria/creatinine ratio >=30
change of proteinuria between groups
Time frame: through study completion, every 1 year
proteinuria/creatine ratio >=150
change of proteinuria between groups
Time frame: through study completion, every 1 year
SF-36
change of score between groups
Time frame: through study completion, every 1 year
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