A study among Karachi communities in Pakistan found that a simple, inexpensive public health intervention which combines home health education along with trained general practitioners can help prevent chronic kidney disease among adults with hypertension.
The study, “Health Education and General Practitioner Training in Hypertension Management: Long-Term Effects on Kidney Function,” was published in the Clinical Journal of the American Society of Nephrology (CJASN).
Individuals with advanced CKD require dialysis or a kidney transplant to sustain life. But these treatments are expensive for most CKD patients in developing countries, where there is a lack of information concerning public health interventions to preserve kidney health and prevent the disease.
Tazeen Jafar, M.D., MPH, along with colleagues from Pakistan, the United Kingdom, and Singapore conducted an extended follow-up study of 1,271 people ages 40 and older with hypertension and serum creatinine measurements with two years in-trial and five years of post-trial period in 12 randomly selected low-income communities in Karachi, Pakistan.
The intervention was delivered over two years and involved training community health workers on aspects of a healthy lifestyle (such as improving diet, increasing physical activity, stopping smoking, and taking blood pressure medication) and training community general clinicians on the newest criteria to manage hypertension.
Among adults who completed the intervention, after seven years of follow-up, kidney function remained unchanged, and those who received standard care had a deterioration in kidney function. Individuals in the communities who received the combined intervention were half as likely as other individuals to experience a greater than 20 percent kidney function decline.
“We show that such a practical model based on primary care doctor training coupled with lifestyle advice from non-physician health workers is likely to have a long-term benefit on preserving kidney function at a population level,” Jafar said in a news release. “These simple strategies can be implementable in other low- and middle-income countries with similar risk factor burden and health systems infrastructure.”
In an accompanying editorial, Min Jun MScMed, Ph.D., and Brenda Hemmelgarn, M.D., Ph.D., (University of Calgary, Canada) noted that adequate blood pressure control among high-risk patient groups such as those with CKD is as low as 13.2 percent, and awareness of CKD is lower in developing countries than in developed countries.
“It follows that simple interventions based on education and communication of the importance of established prevention strategies including blood pressure management may have a significant impact at the population level,” they wrote. “This therefore warrants further consideration, including the assessment of the cost-effectiveness and sustainability of prevention strategies specific to CKD management in developing countries.”