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Trends and Predictors

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

Arch Intern Med. 2008;168(20):2268-2275.

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, 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.

Author Affiliations: Departments of Epidemiology (Ms Plantinga and Drs Boulware, Coresh, and Powe), Biostatistics (Dr Coresh), and Health Policy and Management (Dr Powe), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Medicine, Johns Hopkins School of Medicine, Baltimore (Drs Boulware, Coresh, Miller, and Powe); Department of Medicine, Tufts–New England Medical Center, Boston, Massachusetts (Drs Stevens and Levey); and Departments of Medicine (Dr Saran) and Biostatistics, School of Public Health (Ms Messer), University of Michigan, Ann Arbor.

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