Prevalence, Awareness, and Management of CKD and Cardiovascular Risk Factors in Publicly Funded Health Care

Verhave, Jacobien C.; Troyanov, Stéphan; Mongeau, Frédéric; Fradette, Lorraine; Bouchard, Josée; Awadalla, Philip; Madore, François

doi:10.2215/cjn.06550613

Cited by 55 publications

(51 citation statements)

References 35 publications

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“…While we cannot directly apply this factor to current national estimates of awareness, our data suggest that CKD awareness may have exceeded the Healthy People 2020 target of 13.4% (2). However, CKD awareness remains lower than awareness of diabetes and hypertension (32). Similar to CKD, diabetes and hypertension are often asymptomatic yet still require active patient selfmanagement, including daily medication adherence.…”

Section: Discussionmentioning

confidence: 99%

Variation in Patients’ Awareness of CKD according to How They Are Asked

Tuot

Zhu

Velásquez³

et al. 2016

CJASN

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Background and objectives Awareness of CKD is necessary for patient engagement and adherence to medical regimens. Having an accurate tool to assess awareness is important. Use of the National Health and Nutrition Examination Survey (NHANES) CKD awareness question "Have you ever been told by a doctor or other health professional that you had weak or failing kidneys (excluding kidney stones, bladder infections, or incontinence)?" produces surprisingly low measures of CKD awareness. We sought to compare the sensitivity and specificity of different questions ascertaining awareness of CKD and other health conditions.Design, setting, participants, & measurements Between August of 2011 and August of 2014, an in-person questionnaire was administered to 220 adults with CKD, diabetes, hypertension, or hyperlipidemia who received primary care in a public health care delivery system to ascertain awareness of each condition. CKD awareness was measured using the NHANES question, and other questions, asking if patients knew about their "kidney disease", "protein in the urine", "kidney problem", or "kidney damage." Demographic data were self-reported; health literacy was measured. The sensitivity and specificity of each question was calculated using the medical record as the gold standard.Results In this diverse population (9.6% white, 40.6% black, 36.5% Hispanic, 12.3% Asian), the mean age was 58 years, 30% had a non-English language preference, and 45% had low health literacy. Eighty percent of participants had CKD, with a mean eGFR of 47.2 ml/min per 1.73 m 2 . The sensitivities of each CKD awareness question were: 26.4% for "kidney damage", 27.7% for "kidney disease", 33.2% for "weak or failing kidneys", 39.8% for "protein in the urine", and 40.1% for "kidney problem." Specificities ranged from 82.2% to 97.6%. The best two-question combination yielded a sensitivity of 53.1% and a specificity of 83.3%. This was lower than awareness of hypertension (90.1%) or diabetes (91.8%).Conclusions CKD awareness is low compared with other chronic diseases regardless of how it is ascertained. Nevertheless, more sensitive questions to ascertain CKD awareness suggest current under-ascertainment.

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Section: Discussionmentioning

confidence: 99%

Variation in Patients’ Awareness of CKD according to How They Are Asked

Tuot

Zhu

Velásquez³

et al. 2016

CJASN

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“…We excluded three with a known history of renal disease. The remaining 943 were 5469 years old, with 51% women and a body mass index (BMI) of 26 (23)(24)(25)(26)(27)(28)(29)(30) (Table 1); 83% were white, 5% had a parent from Africa, 1% had a parent from Latin America, 4% had a parent from the Middle East, 2% were Asian, and 5% were from another descent. Cardiovascular risk factors and history were prevalent: 28% reported hyperlipidemia, 17% reported hypertension, 11% reported diabetes, and 6.7% had a history of coronary artery disease or stroke.…”

Section: Cohort Characteristicsmentioning

confidence: 99%

Clinical, Genetic, and Urinary Factors Associated with Uromodulin Excretion

Troyanov

Delmas-Frenette

Bollée

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives The urinary excretion of uromodulin is influenced by common variants in the UMOD gene, and it may be related to NaCl retention and hypertension. Levels of uromodulin are also dependent of the renal function, but other determinants remain unknown.Design, setting, participants, & measurements We tested associations between the urinary excretion of uromodulin; medical history and medication; serum and urinary levels of electrolytes, glucose, and uric acid; and the genotype at the UMOD/Protein Disulfide Isomerase-Like, Testis Expressed locus (rs4293393 and rs12446492); 943 participants from the CARTaGENE Cohort, a random sample from the Canadian population of 20,004 individuals, were analyzed. Participants with available genotyping were obtained from a substudy addressing associations between common variants and cardiovascular disease in paired participants with high and low Framingham risk scores and vascular rigidity indexes.Results The population studied was 5469 years old, with 51% women and eGFR of 9614 ml/min per 1.73 m 2 . Uromodulin excretion was 25 (11-42) mg/g creatinine. Using linear regression, it was independently higher among patients with higher eGFR, the TT genotype of rs4293393, and the TT genotype of rs12446492. The fractional excretions of urate and sodium showed a strong positive correlation with uromodulin, likely linked to the extracellular volume status. The presence of glycosuria and the use of uricosuric drugs, which both increased the fraction excretion of urate, were independently associated with a lower uromodulin excretion, suggesting novel interactions between uric acid and uromodulin excretion. ConclusionsIn this large cohort, the excretion of uromodulin correlates with clinical, genetic, and urinary factors. The strongest associations were between uric acid, sodium, and uromodulin excretions and are likely linked to the extracellular volume status.

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“…Another study among Hispanic/Latinos in the USA also reported only 29.5% patients with dyslipidaemia were receiving lipid lowering treatment 8. Furthermore, a study in Canada among patients with moderate to high Framingham risk scores found that many of them were not receiving a statin 9. A local study, using the Pooled Cohort Risk Score in primary care patients to identify the need for statins, reported that there was both underuse of statin therapy in those who required it and overuse of statins in those who did not qualify for it 10.…”

Section: Introductionmentioning

confidence: 99%

Awareness, knowledge and practice of dyslipidaemia management among postgraduate primary care trainees in Malaysia: a cross-sectional study

Said

Chia

2017

BMJ Open

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ObjectivesDyslipidaemia is one of the main risk factors for cardiovascular disease, the leading cause of death in Malaysia. This study assessed the awareness, knowledge and practice of lipid management among primary care physicians undergoing postgraduate training in Malaysia.DesignCross sectional study.SettingPostgraduate primary care trainees in Malaysia.Participants759 postgraduate primary care trainees were approached through email or hard copy, of whom 466 responded.MethodA self-administered questionnaire was used to assess their awareness, knowledge and practice of dyslipidaemia management. The total cumulative score derived from the knowledge section was categorised into good or poor knowledge based on the median score, where a score of less than the median score was categorised as poor and a score equal to or more than the median score was categorised as good. We further examined the association between knowledge score and sociodemographic data. Associations were considered significant when p<0.05.ResultsThe response rate achieved was 61.4%. The majority (98.1%) were aware of the national lipid guideline, and 95.6% reported that they used the lipid guideline in their practice. The median knowledge score was 7 out of 10; 70.2% of respondents scored 7 or more which was considered as good knowledge. Despite the majority (95.6%) reporting use of guidelines, there was wide variation in their clinical practice whereby some did not practise based on the guidelines. There was a positive significant association between awareness and the use of the guideline with knowledge score (p<0.001). However there was no significant association between knowledge score and sociodemographic data (p>0.05).ConclusionsThe level of awareness and use of the lipid guideline among postgraduate primary care trainees was good. However, there were still gaps in their knowledge and practice which are not in accordance with standard guidelines.

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Prevalence, Awareness, and Management of CKD and Cardiovascular Risk Factors in Publicly Funded Health Care

Cited by 55 publications

References 35 publications

Variation in Patients’ Awareness of CKD according to How They Are Asked

Variation in Patients’ Awareness of CKD according to How They Are Asked

Clinical, Genetic, and Urinary Factors Associated with Uromodulin Excretion

Awareness, knowledge and practice of dyslipidaemia management among postgraduate primary care trainees in Malaysia: a cross-sectional study

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