A Primary-Secondary Care Partnership to Prevent Adverse Outcomes in Chronic Kidney Disease

NCT ID: NCT01688141

Last Updated: 2020-04-08

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

28304 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-01-31

Study Completion Date

2018-10-11

Brief Summary

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Chronic kidney disease (CKD) is a major public health problem with a UK prevalence of 8-10%. The study hypothesis is to ascertain if intensive primary care led disease management programmes for CKD, supported by input from secondary care specialists will slow progression of CKD, improve blood pressure control and reduce cardiovascular events in patients on CKD registers.

The investigators have partnered with Nene commissioning, a practice based commissioning group representing approximately 80 GP practices in Northamptonshire, to run this study. This will be a cluster randomised trial of an intensive, secondary care supported, CKD management programme in primary care vs normal CKD care. Randomisation will be at the level of the individual general practice. All general practices associated with Nene commissioning will be invited to participate. Randomisation of practices will be performed by the University of Leicester Clinical Trials Unit and the study will adhere to guidelines for undertaking randomised cluster trials.

The aims of the study are:

1. To determine whether reinforcement of best practice in the management of key aspects of CKD care by clinical nurse specialists based in primary care, but with close links to colleagues from secondary care, improves clinical outcomes.
2. To foster excellence in CKD care
3. To improve coding of CKD and prevalence on chronic disease registers.
4. To increase interest in, and capacity for primary care research in Northamptonshire.
5. To implement and evaluate a new model of partnership working between primary and secondary care.

The primary outcome measures will be changes in estimated glomerular filtration rate (eGFR). Secondary outcome measures will be blood pressure control, proteinuria, incidence of cardiovascular events,other biochemical parameters, referrals to secondary care and hospitalisations and mortality.

Detailed Description

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see above

Conditions

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Chronic Kidney Disease

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Control

Usual care

Group Type NO_INTERVENTION

No interventions assigned to this group

Enhanced Management

Practices randomised to the intervention group will be offered an enhanced level of CKD disease management led by clinical nurse specialists based on an intervention previously piloted in high risk patients. Here, high risk patients identified will be invited to a CKD clinic for tailored management of bp and proteinuria and referral as needed.

Group Type ACTIVE_COMPARATOR

Enhanced management

Intervention Type OTHER

Specialist nurses providing enhanced CKD management using NICE guidelines and enhanced access to secondary care.

Interventions

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Enhanced management

Specialist nurses providing enhanced CKD management using NICE guidelines and enhanced access to secondary care.

Intervention Type OTHER

Other Intervention Names

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CKD management

Eligibility Criteria

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Inclusion Criteria

* measurement of serum creatinine
* eGFR \< 60 ml/min/1.73m2
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospitals, Leicester

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Nigel Brunskill, PhD

Role: PRINCIPAL_INVESTIGATOR

Consultant

Locations

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Leicester General Hospital

Leicester, Leics, United Kingdom

Site Status

University Hospitals Leicester

Leicester, Leics, United Kingdom

Site Status

University Hospitals of Leicester

Leicester, , United Kingdom

Site Status

Countries

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United Kingdom

References

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Major RW, Brown C, Shepherd D, Rogers S, Pickering W, Warwick GL, Barber S, Ashra NB, Morris T, Brunskill NJ. The Primary-Secondary Care Partnership to Improve Outcomes in Chronic Kidney Disease (PSP-CKD) Study: A Cluster Randomized Trial in Primary Care. J Am Soc Nephrol. 2019 Jul;30(7):1261-1270. doi: 10.1681/ASN.2018101042. Epub 2019 May 16.

Reference Type BACKGROUND
PMID: 31097609 (View on PubMed)

Other Identifiers

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Shelton

Identifier Type: -

Identifier Source: org_study_id

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