Abstract
            Introduction: The mortality rate from chronic kidney disease (CKD) at all ages has increased  worldwide. It is possible to eliminate the progression of CKD, as it can be treated with early  diagnosis and treatment.  
  Objectives: This research aims to study the changes in the stages of the disease and clinical  outcomes in patients with the third and fourth stages of CKD.  
  Patients and Methods: This research is a retrospective analytic study in patients diagnosed  with third- and fourth-stage of CKD at the Tha Chang Hospital, Thailand. The research  sample consisted of 169 medical records of a small population with a confidence level of 0.95.  Research data were collected between October 2019 and March 2021. Data analysis utilized  frequency, percentage, paired t test, and Wilcoxon signed-rank test.  
  Results: The results revealed that after one year of attending the clinic, the average systolic  blood pressure (SBP), diastolic blood pressure (DBP), triglyceride (TG), hemoglobin A1c  (HbA1c), uric acid, high-density lipoprotein (HDL), estimated glomerular filtration rate  (eGFR), and urine microalbumin had no differences. However, the average body mass index  (BMI), total cholesterol (TC), low-density lipoprotein (LDL), and serum creatinine (sCr)  showed statistically significant differences at P<0.05. Most patients with CKD were in stable  health conditions and disease stage (87.57%).  
  Conclusion: The third and fourth-stage CKD care model could be achieved by the  multidisciplinary care team and requires a strategy that is sustainable in addition to  continuous care by involving a family member and caregiver in the community.