Sri Lekha Tummalapalli1,2,3, Eric Vittinghoff4, Deidra C Crews5,6,7, Mary Cushman8, Orlando M Gutiérrez9,10, Suzanne E Judd11, Holly J Kramer12,13, Carmen A Peralta14,15,16,17, Delphine S Tuot14,18,19, Michael G Shlipak15,16,20, Michelle M Estrella14,15,16. 1. Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA, lekha.tummalapalli@gmail.com. 2. Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California, USA, lekha.tummalapalli@gmail.com. 3. San Francisco Veterans Affairs Health Care System San Francisco, San Francisco, California, USA, lekha.tummalapalli@gmail.com. 4. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA. 5. Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. 6. Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. 7. Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 8. Departments of Medicine and Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA. 9. Department of Epidemiology, Birmingham, Alabama, USA. 10. Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. 11. Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA. 12. Department of Public Health Sciences and Medicine, Chicago, Illinois, USA. 13. Division of Nephrology and Hypertension, Loyola University, Chicago, Illinois, USA. 14. Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA. 15. Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California, USA. 16. San Francisco Veterans Affairs Health Care System San Francisco, San Francisco, California, USA. 17. Cricket Health, Inc., San Francisco, California, USA. 18. Center for Innovation in Access and Quality at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA. 19. Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California, San Francisco, California, USA. 20. Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.
Abstract
BACKGROUND: The majority of people with chronic kidney disease (CKD) are unaware of their kidney disease. Assessing the clinical significance of increasing CKD awareness has critical public health and healthcare delivery implications. Whether CKD awareness among persons with CKD is associated with longitudinal health behaviors, disease management, and health outcomes is unknown. METHODS: We analyzed data from participants with CKD in the REasons for Geographic And Racial Differences in Stroke study, a national, longitudinal, population-based cohort. Our predictor was participant CKD awareness. Outcomes were (1) health behaviors (smoking avoidance, exercise, and nonsteroidal anti-inflammatory drug use); (2) CKD management indicators (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, statin use, systolic blood pressure, fasting blood glucose, and body mass index); (3) change in estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR); and (4) health outcomes (incident end-stage kidney disease [ESKD], coronary heart disease [CHD], stroke, and death). Logistic and linear regressions were used to examine the association of baseline CKD awareness with outcomes of interest, adjusted for CKD stage and participant demographic and clinical factors. RESULTS: Of 6,529 participants with baseline CKD, 285 (4.4%) were aware of their CKD. Among the 3,586 participants who survived until follow-up (median 9.5 years), baseline awareness was not associated with subsequent odds of health behaviors, CKD management indicators, or changes in eGFR and UACR in adjusted analyses. Baseline CKD awareness was associated with increased risk of ESKD (adjusted hazard ratio [aHR] 1.44; 95% CI 1.08-1.92) and death (aHR 1.18; 95% CI 1.00-1.39), but not with subsequent CHD or stroke, in adjusted models. CONCLUSIONS: Individuals aware of their CKD were more likely to experience ESKD and death, suggesting that CKD awareness reflects disease severity. Most persons with CKD, including those that are high-risk, remain unaware of their CKD. There was no evidence of associations between baseline CKD awareness and longitudinal health behaviors, CKD management indicators, or eGFR decline and albuminuria.
BACKGROUND: The majority of people with chronic kidney disease (CKD) are unaware of their kidney disease. Assessing the clinical significance of increasing CKD awareness has critical public health and healthcare delivery implications. Whether CKD awareness among persons with CKD is associated with longitudinal health behaviors, disease management, and health outcomes is unknown. METHODS: We analyzed data from participants with CKD in the REasons for Geographic And Racial Differences in Stroke study, a national, longitudinal, population-based cohort. Our predictor was participant CKD awareness. Outcomes were (1) health behaviors (smoking avoidance, exercise, and nonsteroidal anti-inflammatory drug use); (2) CKD management indicators (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, statin use, systolic blood pressure, fasting blood glucose, and body mass index); (3) change in estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR); and (4) health outcomes (incident end-stage kidney disease [ESKD], coronary heart disease [CHD], stroke, and death). Logistic and linear regressions were used to examine the association of baseline CKD awareness with outcomes of interest, adjusted for CKD stage and participant demographic and clinical factors. RESULTS: Of 6,529 participants with baseline CKD, 285 (4.4%) were aware of their CKD. Among the 3,586 participants who survived until follow-up (median 9.5 years), baseline awareness was not associated with subsequent odds of health behaviors, CKD management indicators, or changes in eGFR and UACR in adjusted analyses. Baseline CKD awareness was associated with increased risk of ESKD (adjusted hazard ratio [aHR] 1.44; 95% CI 1.08-1.92) and death (aHR 1.18; 95% CI 1.00-1.39), but not with subsequent CHD or stroke, in adjusted models. CONCLUSIONS: Individuals aware of their CKD were more likely to experience ESKD and death, suggesting that CKD awareness reflects disease severity. Most persons with CKD, including those that are high-risk, remain unaware of their CKD. There was no evidence of associations between baseline CKD awareness and longitudinal health behaviors, CKD management indicators, or eGFR decline and albuminuria.
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Authors: Pankti A Gheewala; Gregory M Peterson; Syed Tabish R Zaidi; Matthew D Jose; Ronald L Castelino Journal: BMC Public Health Date: 2018-03-20 Impact factor: 3.295
Authors: Susanne Stolpe; Bernd Kowall; Christian Scholz; Andreas Stang; Cornelia Blume Journal: Int J Environ Res Public Health Date: 2021-11-09 Impact factor: 3.390
Authors: Delphine S Tuot; Susan T Crowley; Lois A Katz; Joseph Leung; Delly K Alcantara-Cadillo; Christopher Ruser; Elizabeth Talbot-Montgomery; Joseph A Vassalotti Journal: JMIR Form Res Date: 2022-09-28