WEIGHT: 47 kg
Sex services: Striptease, Receiving Oral, Bondage, Face Sitting, Cross Dressing
In developing countries, accessibility to specialists, and physician to patient contact time is limited. We conducted a community-based, cluster randomized controlled trial at Kamphaeng Phet Province, located about kilometers north of Bangkok. Two out of eleven districts of the province were randomly selected. Approximatly stage 3—4 CKD patients from 2 districts were enrolled.
Patients in both groups will be treated with standard guidelines. The patients in intervention group were provided the additional treatments by multidisciplinary team in conjunction with community CKD care network subdistrict health care officers and VHVs which will provide group counseling during each hospital visit and quarterly home visits to monitor dietary protein and sodium intake, blood pressure measurement and drug compliance.
The primary outcome is the difference of rate of eGFR decline. The secondary outcomes are laboratory parameters and incidence of clinical endpoints such as mortality rate and cardiovascular events, end-stage renal disease ESRD , etc. Insights of this study may set forth a new standard of community-based CKD care. According to a recent community-based survey among Thais, the prevalence of pre-dialysis stage 3, 4 and 5 CKD was 8.
It is estimated that the total number of stage 3—4 CKD patients in Thailand is 4. With only active nephrologists, the ratio of CKD patients to nephrologists in Thailand is as high as 1: The high ratio indicates that accessibility to nephrologist may not be equal for all CKD patients.
At present, Thai CKD care is still based on conventional method in which a hospital-based, physician-oriented approach provided at the out-patient department [ 2 - 4 ]. In rural areas where physician-to-patient contact time is more limited and renal specialists are scarce or not existing, this kind of health care service is impractical. Thus, it is mandatory to seek other appropriate forms of renal care to delay CKD progression. Thailand is geographically divided into 77 provinces.