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. 2021 Jun 1;3(4):576-585.e1.
doi: 10.1016/j.xkme.2021.03.014. eCollection 2021 Jul-Aug.

Patient Awareness of CKD: A Systematic Review and Meta-analysis of Patient-Oriented Questions and Study Setting

Chi D Chu  1 , Michael H Chen  2 , Charles E McCulloch  3 , Neil R Powe  1   4   5 , Michelle M Estrella  6   7 , Michael G Shlipak  6   7 , Delphine S Tuot  1   4   5
Affiliations

Patient Awareness of CKD: A Systematic Review and Meta-analysis of Patient-Oriented Questions and Study Setting

Chi D Chu et al. Kidney Med. .

Abstract

Rationale & objective: Patient awareness of disease is the first step toward effective management and disease control. Awareness of chronic kidney disease (CKD) has consistently been shown to be low, but studies estimating patient awareness of CKD have used different methods. We sought to determine whether the estimated prevalence of CKD awareness differed by the wording used to ascertain awareness or by setting characteristics.

Study design: Systematic review and meta-analysis.

Setting & study populations: Adults with CKD not receiving dialysis.

Selection criteria for studies: We included studies that estimated CKD awareness, determined CKD status by laboratory criteria, and provided the exact question wording used to ascertain awareness.

Data extraction: 2 reviewers independently extracted data for each study; discordance was resolved by a third independent reviewer.

Analytical approach: Mixed-effects models were used to calculate pooled CKD awareness estimates and 95% CIs.

Results: 32 studies were included. Publication year ranged from 2004 to 2017, with study populations ranging from 107 to 28,923 individuals. CKD awareness in individual studies ranged from 0.9% to 94.0%. Pooled CKD awareness was 19.2% (95% CI, 10.0%-33.6%) overall and was 26.5% (95% CI, 11.9%-48.9%) among individuals with an estimated glomerular filtration rate < 60 mL/min/1.73 m2. "Kidney problem" was the most sensitive question for CKD awareness (58.7%; 95% CI, 32.4%-80.8%); "weak or failing kidneys" was the least sensitive (12.3%; 95% CI, 4.5%-29.4%). CKD awareness was highest among patients from nephrology practices (86.2%; 95% CI, 74.9%-93.0%) and lowest in the general population (7.3%; 95% CI, 5.0%-10.5%).

Limitations: Significant heterogeneity across studies overall and among examined subgroups of wording and study setting.

Conclusions: Differently worded questions may lead to widely different estimates of CKD awareness. Consistent terminology is likely needed to most effectively surveil and leverage CKD awareness to improve management and disease control.

Keywords: CKD awareness; Chronic kidney disease; knowledge; meta-analysis; review.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram. Abbreviation: CKD, chronic kidney disease.
Figure 2
Figure 2
Meta-analysis of chronic kidney disease awareness prevalence. An individual study may be represented by more than 1 marker if it reported multiple estimates of awareness using different survey questions.
Figure 3
Figure 3
Meta-analysis of chronic kidney disease awareness prevalence, grouped by terminology used to ascertain awareness. Heterogeneity by wording subgroup: “kidney disease” (P < 0.001; I2 = 99.4%), “weak or failing kidneys” (P < 0.001; I2 = 99.5%), “kidney problem” (P < 0.001; I2 = 99.2%), and “chronic kidney disease” (P < 0.001; I2 = 99.5%). An individual study may be represented by more than 1 marker if it reported multiple estimates of awareness using different survey questions.
Figure 4
Figure 4
Meta-analysis of chronic kidney disease awareness prevalence, grouped by study setting. Heterogeneity by setting subgroup: general public (P < 0.001; I2 = 98.9%), primary care (P < 0.001; I2 = 99.3%), hospital (P < 0.001; I2 = 99.3%), and nephrology clinic (P < 0.001; I2 = 98.9%). An individual study may be represented by more than 1 marker if it reported multiple estimates of awareness using different survey questions (numbered [1] weak or failing kidneys; [2] kidney disease; [3] kidney problem; [4] kidney damage; [5] protein in the urine; [6] chronic kidney disease).
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