Delphine S. Tuot
While CKD awareness among diverse community-dwelling adults has reached the Healthy People 2020 goal, awareness overall remains low, according to a recently published study.
“Nationally, there may been many efforts to increase individual awareness of CKD assuming that increased awareness will lead to improved health outcomes,” lead study author, Delphine S. Tuot, MDCM, MAS, associate professor of the University of California, San Francisco division of nephrology at the Zuckerberg San Francisco General Hospital, told Healio/Nephrology. “But studies have not shown that CKD awareness is associated with participation in healthy behaviors, better blood pressure control, increased use of [angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers] ACEI/ARB or slower CKD progression. This is likely multifactorial, including the way in which CKD awareness is measured. We wanted to further examine this measurement aspect and see how diverse adults responded to different CKD awareness questions.”
Tuot and her colleagues conducted a cross-sectional study using data from 2,046 patients with CKD who completed wave four of the Healthy Aging in Neighborhoods of Diversity Across the Life Span study, which was designed to identify the effects of race and socioeconomic status on the development of cardiovascular and cerebrovascular diseases. Mean age of the study participants was 56.5 years; 41.5% were men; 61.3% were African American; 40% were poor and 20% had CKD.
In wave 4, participants were asked four questions regarding their CKD awareness. The questions asked whether patients had been told by a doctor or health care professional that they have kidney disease, protein in the urine, a kidney problem or kidney damage.
After examining the sensitivity and specificity of the different CKD awareness questions, researchers found sensitivity was higher in participants with advanced CKD, had low health literacy and lived below the poverty line.
“Results confirm that CKD awareness is low among adults with kidney disease, but it may not be as low as we think,” Tuot said. “A sensitive compound question ascertaining awareness suggests CKD awareness is roughly 20% among community adults, which is higher than our national goal for 2020.”
According to Tuot and her colleagues, patients with a lower understanding of their kidney disease may be less inclined to self-manage their disease to improve kidney health. Additionally, patients who do not understand or are not aware of their CKD might not adhere to their medications, cease tobacco use, exercise or avoid other medications proven to be nephrotoxic.
“This study had three key findings, none of which were that surprising. First, it corroborated prior work that awareness of CKD is low among adults,” Tuot said. “Second, it confirmed prior work performed in one health system that the detection of awareness differs by how the question is asked. The question currently used in national health surveys, ‘Have you ever been told by a doctor or health care provider that you have weak or failing kidneys (excluding stones, bladder infections or incontinence)?’ is likely poorly estimating true CKD awareness. Third, it provided additional evidence that using a compound question asking about kidney disease and proteinuria likely performs better than the aforementioned question.”
Tuot added that higher levels of CKD awareness are not only important for clinical care but are also essential from a public health perspective.
“We need to better understand how patients speak about kidney disease and what makes the most sense to them to develop more robust educational materials and national campaigns,” Tuot said. “This could also be used to develop new tools to help primary care providers discuss kidney disease. These efforts will allow us to better target future awareness messages and more accurately evaluate campaign successes.” – by Scott Buzby
Disclosures: The researchers reported no relevant financial disclosures.