The EAL is seeking RDNs and NDTRs who work with patients, clients, or the public to treat children and adolescents living with type 1 diabetes, for participation in a usability test and focus group. Interested participants should email a professional resume to by July 15, 2024.

MNT: RDN in Medical Team (2015)

Tungsanga K, Ratanakul C, Pooltavee W, Mahatanan N, Ayuthaya AIN, Rodpai S. Experience with prevention programs in Thailand. Kidney International. 2005; 67(Suppl 94): S68-S69. PubMed ID: 15752244
Study Design:
Before-After Study
D - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:
To evaluate effectiveness of multi-disciplinary care team approach for the prevention of renal disease progression in Thailand.
Inclusion Criteria:
Received care for early-stage chronic kidney disease (CKD) at the King Chulalongkorn Memorial Hospital.
Exclusion Criteria:
Did not receive care for early stage chronic kidney disease (CKD) at the King Chulalongkorn Memorial Hospital.
Description of Study Protocol:


Recruited from the King Chulalongkorn Memorial Hospital.


The Nephrology Society of Thailand conducted a survey among Thai nephrologists. Data was analyzed and a multi-disciplinary team approach was introduced to make patients more informed about CKD and more compliant with dietary prescription. The multi-disciplinary care team was comprised of nephrologists, renal nurses and a dietitian. Optimum target for blood pressure control (125/75mm Hg), use of angiotensin-converting enzyme inhibition or angiotensin receptor blockage if indicated, phosphate binders and control of metabolic acidosis with bicarbonate therapy were employed in all cases. Patients who smoked were encouraged to stop smoking. Dietary protein intake was controlled at 0.6g to 0.8g per kg per day and tools were developed to assist patients with this restriction. All cases were followed up at the outpatient clinic and blood and 24-hour urine protein were monitored periodically. 


Standardized multi-disciplinary team approach.



Data Collection Summary:

Timing of Measurements

  • Regular clinical and dietary assessment by care team; no additional details were described regarding timing
  • Serum biochemistries, creatinine clearance and 24-hour urine collection monitored periodically; no additional details were described regarding timing

Dependent Variables

  • Serum creatinine (mg per dL)
  • Creatinine clearance (ml per minute)
  • Glomerular filtration rate (GFR) (ml per minute)
  • 24-hour urine protein (g per day).

Independent Variables

Multi-disciplinary team approach to delay CKD progression.
Description of Actual Data Sample:
  • Initial N: N=17 patients (gender not described)
  • Attrition (final N): N=17 patients
  • Ethnicity: Thai
  • Location: Thailand.


Summary of Results:

Key Findings

After a mean follow-up of four years in 17 patients,there was a slight increase in serum creatinine and a slight but not significant decrease in creatinine clearance.



After Four Years

Rate of Change per Year

Serum creatinine (mg per dL)




Creatinine clearance (ml per minute)




GFR (ml per minute)




24-hour urine protein (g per day) 1.0±0.2 0.8±0.2 -0.04±0.05
Author Conclusion:
Active and intensive multi-disciplinary care in CKD patients can effectively delay or even halt renal disease progression.
Funding Source:
Other: Not described
Reviewer Comments:
Study limitations include:
  • Small number of subjects
  • No data regarding subjects' compliance to multi-disciplinary recommendations
  • No discussion of statistical analysis.
Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) Yes
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) Yes
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? Yes
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? Yes
  2.2. Were criteria applied equally to all study groups? Yes
  2.3. Were health, demographics, and other characteristics of subjects described? No
  2.4. Were the subjects/patients a representative sample of the relevant population? Yes
3. Were study groups comparable? N/A
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? N/A
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? Yes
  4.1. Were follow-up methods described and the same for all groups? No
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? Yes
  4.4. Were reasons for withdrawals similar across groups? Yes
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? Yes
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? No
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) Yes
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? No
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? Yes
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? Yes
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? No
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? No
  6.6. Were extra or unplanned treatments described? No
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? Yes
  7.1. Were primary and secondary endpoints described and relevant to the question? Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern? Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? Yes
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? Yes
  7.5. Was the measurement of effect at an appropriate level of precision? Yes
  7.6. Were other factors accounted for (measured) that could affect outcomes? No
  7.7. Were the measurements conducted consistently across groups? Yes
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? No
  8.1. Were statistical analyses adequately described and the results reported appropriately? No
  8.2. Were correct statistical tests used and assumptions of test not violated? ???
  8.3. Were statistics reported with levels of significance and/or confidence intervals? Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? Yes
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? No
  8.6. Was clinical significance as well as statistical significance reported? Yes
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? No
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? No
10. Is bias due to study's funding or sponsorship unlikely? Yes
  10.1. Were sources of funding and investigators' affiliations described? No
  10.2. Was the study free from apparent conflict of interest? Yes