Chronic Kidney Disease Awareness and Longitudinal Health Outcomes: Results from the REasons for Geographic And Racial Differences in Stroke Study

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 nation-al, longitudinal, population-based cohort. Our predictor was participant CKD awareness. Outcomes were (1) health behaviors (smoking avoidance, exercise, and nonsteroidal antiinflammatory 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 albuminto-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 Tummalapalli et al.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.

High Unawareness of Chronic Kidney Disease in Germany

“…Last, in our analysis, few patients aged <50 years were included as the BIS cohort recruited only persons aged 70 years and older. However, in DIACORE and CAD-Ref, the proportion of younger patients was 25% and comparable to other cohorts [43]. Proportions of unaware CKD patients in age group <50 years were 82% (DIACORE) and 92% (CAD-Ref).…”

“…However, CKD prevalence in patients with eGFR < 60 mL/min/1.73 m 2 (CKD Stages 3-4) might be overestimated. As many cross-sectional epidemiologic studies are limited to a single eGFR measurement in defining CKD, the comparability of our results is facilitated [37,43,44]. However, we do not have information on educational attainment or social status, which might be associated with patient awareness.…”

Person-Centered Kidney Education: The Path Forward

“…Similarly, Chu et al 4 found that between 2011 and 2016, CKD awareness ranged from 10% to just 49% among low- and high-risk groups, respectively. Tummalapalli et al 5 found that of 6,529 participants with CKD, just 4.4% were aware of their CKD. CKD awareness was associated with 1.44 increased odds of ESKD.…”

“…These studies and others suggest that CKD awareness, although universally low, is higher among people with more advanced disease, highlighting the need for education at early stages of CKD. 5 …”

“…These studies and others suggest that CKD awareness, although universally low, is higher among people with more advanced disease, highlighting the need for education at early stages of CKD. 5 Patient education and CKD awareness are associated with better outcomes, including higher rates of pre-ESKD nephrology care, higher likelihood of permanent access use for dialysis initiation, higher rates of satisfaction with care, preemptive transplant wait listing, and transplantation. 6,7 KDIGO (Kidney Disease: Improving Global Outcomes) guidelines provide stage-specific action plans for the continuum of CKD care, emphasizing screening for CKD and its risk factors in the early stages to slow down progression (Fig 1).…”