Patient Awareness of Chronic Kidney Disease

Plantinga, Laura C.; Boulware, L. Ebony; Coresh, Josef; Stevens, Lesley A.; Miller, Edgar R.; Saran, Rajiv; Messer, Kassandra L.; Levey, Andrew S.; Powe, Neil R.

doi:10.1001/archinte.168.20.2268

Cited by 268 publications

(279 citation statements)

References 24 publications

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“…Although this association was expected, the high degree of CKD unawareness among individuals with at least five markers of their kidney disease and the persistence of unawareness over time were not. Our study is consistent with previous investigations demonstrating low levels of individual CKD awareness (1,4,6) but highlights the profound lack of awareness among individuals with an eGFR Ͻ60 ml/min per 1.73 m 2 who have already developed either late complications of kidney disease (hyperkalemia, acidosis, and hyperphosphatemia) or albuminuria, which are associated Analyses have been weighted to reflect the US population. CKD, chronic kidney disease; CI, confidence interval.…”

Section: Discussionsupporting

confidence: 91%

“…Chronic kidney disease (CKD) is a public health concern, affecting an estimated 13% of the US population (1). Better management of CKD can slow progression of renal dysfunction, prevent metabolic complications, and reduce cardiovascular-related outcomes (2).…”

Section: Introductionmentioning

confidence: 99%

“…In the 1999 to 2004 National Health and Nutrition Examination Surveys (NHANES), only 8% and 41% of persons with CKD stages III and IV, respectively, self-reported their CKD (1). Similarly, only 9% of patients with CKD and diabetes in a screening study were aware of their CKD status (7), and only 5% of those with CKD and coronary heart disease self-reported CKD awareness in a cohort study (8).…”

Section: Introductionmentioning

confidence: 99%

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Chronic Kidney Disease Awareness Among Individuals with Clinical Markers of Kidney Dysfunction

Tuot

Plantinga

Hsu

et al. 2011

Clinical Journal of the American Society of Nephrology

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132

107

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SummaryBackground and objectives Awareness of chronic kidney disease (CKD) among providers and patients is low. Whether clinical cues prompt recognition of CKD is unknown. We examined whether markers of kidney disease that should trigger CKD recognition among providers are associated with higher individual CKD awareness.Design, setting, participants, & measurements CKD awareness was assessed in 1852 adults with an estimated GFR Ͻ60 ml/min per 1.73 m 2 using 1999 to 2008 National Health and Nutrition Examination Survey data. CKD awareness was a "yes" answer to "Have you ever been told you have weak or failing kidneys?" Participants were grouped by distribution of the following abnormal markers of CKD: hyperkalemia, acidosis, hyperphosphatemia, elevated blood urea nitrogen, anemia, albuminuria, and uncontrolled hypertension. Odds of CKD awareness associated with each abnormal marker and groupings of markers were estimated by multivariable logistic regression.Results Among individuals with kidney disease, only those with albuminuria had greater odds of CKD awareness (adjusted odds ratio, 4.0, P Ͻ 0.01) than those without. Odds of CKD awareness increased with each additional manifested clinical marker of CKD (adjusted odds ratio, 1.3, P ϭ 0.05). Nonetheless, 90% of individuals with two to four markers of CKD and 84% of individuals with Ն5 markers of CKD were unaware of their disease. ConclusionsAlthough individuals who manifest many markers of kidney dysfunction are more likely to be aware of their CKD, their CKD awareness remains low. A better understanding of mechanisms of awareness is required to facilitate earlier detection of CKD and implement therapy to minimize associated complications.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Chronic Kidney Disease Awareness Among Individuals with Clinical Markers of Kidney Dysfunction

Tuot

Plantinga

Hsu

et al. 2011

Clinical Journal of the American Society of Nephrology

Self Cite

132

107

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“…Despite the presence of multiple cardiovascular risk factors, only 20% of individuals with CKD were prescribed either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker, medications that are known to decrease CKD progression risk (20). Also alarming is our finding that only 18% of individuals with CKD and 34% of those with eGFR creat-cyst ,60 ml/min per 1.73 m 2 were aware of having CKD, which is consistent with prior reports (21,22). These findings suggest that there is considerable opportunity to improve CKD management in Hispanics/Latinos, and there is an urgent need to improve CKD awareness among patients who might be missing important preventive and therapeutic opportunities that may decrease their CKD progression risk.…”

Section: Discussionsupporting

confidence: 89%

Prevalence and Correlates of CKD in Hispanics/Latinos in the United States

Ricardo¹,

Flessner²,

Eckfeldt³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives The prevalence of ESRD among Hispanics/Latinos is 2-fold higher than in non-Hispanic whites. However, little is known about the prevalence of earlier stages of CKD among Hispanics/Latinos. This study estimated the prevalence of CKD in US Hispanics/Latinos. Results The overall prevalence of CKD among Hispanics/Latinos was 13.7%. Among women, the prevalence of CKD was 13.0%, and it was lowest in persons with South American background (7.4%) and highest (16.6%) in persons with Puerto Rican background. In men, the prevalence of CKD was 15.3%, and it was lowest (11.2%) in persons with South American background and highest in those who identified their Hispanic background as "other" (16.0%). The overall prevalence of CKD was similar in HCHS/SOL compared with non-Hispanic whites in NHANES. However, prevalence was higher in HCHS/SOL men and lower in HCHS/SOL women versus NHANES non-Hispanic whites. Low income, diabetes mellitus, hypertension, and cardiovascular disease were each significantly associated with higher risk of CKD.Conclusions Among US Hispanic/Latino adults, there was significant variation in CKD prevalence among Hispanic/Latino background groups, and CKD was associated with established cardiovascular risk factors.

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“…4 CKD is commonly asymptomatic early in the course of the disease and, as a result, awareness of CKD among the general population remains low. 5 Risk factors for CKD identified in prospective studies include age, hypertension, ethnicity, diabetes, smoking, low HDL cholesterol (HDL c ), proteinuria, and obesity. [6][7][8] However, the majority of studies have evaluated risk factors at, or near, the time of diagnosis of CKD when risk factor modification may be too late to prevent progression.…”

mentioning

confidence: 99%

Mid-Adulthood Risk Factor Profiles for CKD

McMahon

Preis

Hwang

et al. 2014

Journal of the American Society of Nephrology

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Early identification of CKD risk factors may allow risk factor modification and prevention of CKD progression. We investigated the hypothesis that risk factors are present $30 years before the diagnosis of CKD in a case-control study using data from the Framingham Offspring Study. Patients with incident CKD (eGFR#60 ml/min per 1.73 m 2 ) at examination cycles 6, 7, and 8 were age-and sex-matched 1:2 to patients without CKD at baseline (examination 5). CKD risk factors were measured at each examination cycle. Logistic regression models, adjusted for age, sex, and time period, were constructed to compare risk factor profiles at each time point between cases and controls. During follow-up, 441 new cases of CKD were identified and matched to 882 controls (mean age 69.2 years, 52.4% women). Those who ultimately developed CKD were more likely to have hypertension (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.23 to 2.51), obesity (OR, 1.71; 95% CI, 1.14 to 2.59), and higher triglyceride levels (OR, 1.43; 95% CI, 1.12 to 1.83) 30 years before CKD diagnosis, and were more likely to have hypertension (OR, 1.38; 95% CI, 1.07 to 1.79), higher triglyceride levels (OR, 1.35; 95% CI, 1.11 to 1.64), lower HDL c (OR, 0.89; 95% CI, 0.81 to 0.97), and diabetes (OR, 2.90; 95% CI, 1.59 to 5.29) 20 years before CKD diagnosis. These findings demonstrate that risk factors for CKD are identifiable $30 years before diagnosis and suggest the importance of early risk factor identification in patients at risk for CKD.

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Patient Awareness of Chronic Kidney Disease

Cited by 268 publications

References 24 publications

Chronic Kidney Disease Awareness Among Individuals with Clinical Markers of Kidney Dysfunction

Chronic Kidney Disease Awareness Among Individuals with Clinical Markers of Kidney Dysfunction

Prevalence and Correlates of CKD in Hispanics/Latinos in the United States

Mid-Adulthood Risk Factor Profiles for CKD

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