Patient awareness of chronic kidney disease: trends and predictors

Abstract

Background: The impact of recent guidelines for early detection and prevention of chronic kidney disease (CKD) on patient awareness of disease and factors that might be associated with awareness have not been well described.

Methods: Awareness rates were assessed in 2992 adults (age, > or =20 years) with CKD stages 1 to 4 from a nationally representative, cross-sectional survey (National Health and Nutrition Examination Survey 1999-2004). Awareness of CKD was defined by an answer of yes to "Have you ever been told you have weak or failing kidneys?" Potential predictors of awareness included demographics, access to care, and clinical and lifestyle factors, which were assessed by standardized interviewer-administered questionnaires and physical examinations. We examined independent associations of patient characteristics with awareness in those with CKD stage 3 (n = 1314) over 6 years using multivariable logistic regression.

Results: Awareness improved over time in those with CKD stage 3 only (4.7% [95% confidence interval {CI}, 2.6%-8.5%], 8.9% [95% CI, 7.1%-11.2%], and 9.2% [95% CI, 6.1%-13.8%] for 1999-2000, 2001-2002, and 2003-2004, respectively; P = .04, adjusted for age, sex, and race). Having proteinuria (odds ratio, 3.04 [95% CI, 1.62-5.70]), diabetes (OR, 2.19 [95% CI, 1.03-4.64]), and hypertension (OR, 2.92 [95% CI, 1.57-5.42]) and being male (OR, 2.06 [95% CI, 1.15-3.69]) were all statistically significantly associated with greater awareness among persons with CKD stage 3 after adjustment. Chronic kidney disease awareness increased almost 2-fold for those with CKD stage 3 over recent years but remains low. Persons with risk factors for CKD (proteinuria, diabetes, hypertension, and male sex) were more likely to be aware of their stage 3 disease.

Conclusion: Renewed and innovative efforts should be made to increase CKD awareness among patients and health care providers.

Figure 1

NHANES participants, 1999-2004, who met inclusion criteria for this study. *Stages 1 and 2 defined by single measurement of albuminuria only; persistent albuminuria data not available.

Figure 2

Proportion of subjects with CKD who were aware of their disease by CKD stage, NHANES 1999-2004. P for trend across stage adjusted for age, sex, and race. *Stages 1 and 2 defined by single measurement of albuminuria only; persistent albuminuria data not available. **No SE estimates due to small sample size. Bars, 95% CI.

Figure 3

Proportion of subjects with CKD stages 1-4 who were aware of their disease by survey year, NHANES 1999-2004. P for trend across years adjusted for age, sex, and race. *Stages 1 and 2 defined by single measurement of albuminuria only; persistent albuminuria data not available. **No SE estimates due to small sample size. Bars, 95% CI.

Figure 4

Association of CKD awareness over time with age (A), race (B), sex (C), proteinuria (D), diabetes (E), and hypertension (F) in NHANES participants 1999-2004 (stage 3 only). Odds ratios are adjusted for other patient characteristics shown plus education and health insurance. *, no estimates, failure predicted perfectly.

Figure 4

Association of CKD awareness over time with age (A), race (B), sex (C), proteinuria (D), diabetes (E), and hypertension (F) in NHANES participants 1999-2004 (stage 3 only). Odds ratios are adjusted for other patient characteristics shown plus education and health insurance. *, no estimates, failure predicted perfectly.

Figure 4

Association of CKD awareness over time with age (A), race (B), sex (C), proteinuria (D), diabetes (E), and hypertension (F) in NHANES participants 1999-2004 (stage 3 only). Odds ratios are adjusted for other patient characteristics shown plus education and health insurance. *, no estimates, failure predicted perfectly.

Figure 4

Association of CKD awareness over time with age (A), race (B), sex (C), proteinuria (D), diabetes (E), and hypertension (F) in NHANES participants 1999-2004 (stage 3 only). Odds ratios are adjusted for other patient characteristics shown plus education and health insurance. *, no estimates, failure predicted perfectly.

Figure 4

Association of CKD awareness over time with age (A), race (B), sex (C), proteinuria (D), diabetes (E), and hypertension (F) in NHANES participants 1999-2004 (stage 3 only). Odds ratios are adjusted for other patient characteristics shown plus education and health insurance. *, no estimates, failure predicted perfectly.

Figure 4

Association of CKD awareness over time with age (A), race (B), sex (C), proteinuria (D), diabetes (E), and hypertension (F) in NHANES participants 1999-2004 (stage 3 only). Odds ratios are adjusted for other patient characteristics shown plus education and health insurance. *, no estimates, failure predicted perfectly.