State-Level Awareness of Chronic Kidney Disease in the U.S.

Abstract

Introduction This study examined state-level variation in chronic kidney disease (CKD) awareness using national estimates of disease awareness among adults in the U.S. with CKD. Methods Data on U.S. adults were obtained from two national, population-based surveys: (1) the Behavioral Risk Factor Surveillance System (BRFSS 2011; n=506,467), a state-level phone survey containing information on self-reported kidney disease; and (2) the National Health and Nutrition Examination Survey (NHANES 2005–2012; n=20,831), containing physical health examination, surveys containing data on self-reported kidney disease, risk factors, and laboratory values. CKD was defined as an estimated glomerular filtration rate of 15–59 mL/minute/1.73 m2 or urinary albumin-to-creatinine ratio >30 mg/g. As BRFSS does not include laboratory data, CKD status for each person was imputed (multiple) based on a logistic regression model predicting NHANES CKD status. CKD awareness in each state was estimated as the weighted proportion of BRFSS participants with imputed CKD who reported having kidney disease. Results Overall, estimated CKD awareness was 9.0% (95% CI=8.0%, 10.0%), ranging from 5.8% (95% CI=4.8%, 6.8%) in Iowa to 11.7% (95% CI=9.7%, 13.7%) in Arizona. Awareness was greater among adults with hypertension (12.0%) and diabetes (15.3%) than among adults without those conditions, and lower in Hispanics (6.0%) than in non-Hispanic whites (8.8%), non-Hispanic blacks (9.9%), and other racial/ethnic groups (12.7%). Conclusions Among individuals with CKD, awareness of their condition was very low and varied approximately twofold among states. This is the first study to estimate awareness of kidney disease by state for the U.S. adult population.

Awareness and Discussions About Chronic Kidney Disease Among African-Americans with Chronic Kidney Disease and Hypertension: a Mixed Methods Study

“…For instance, ACT participants were mailed their study laboratory results, which may have prompted subsequent CKD discussions by both participants and PCPs. Our finding that 29% were aware of CKD is consistent with prior work demonstrating 6-40% awareness of CKD in national surveys 12,[32][33][34][35] and outpatient settings. 36,37 In contrast to other studies noting an association between CKD awareness and diagnosis of diabetes, 12, 32 we did not find this association.…”

Exploring reasons for state-level variation in incidence of dialysis-requiring acute kidney injury (AKI-D) in the United States

“…We were not able to account for any potential differences in threshold to initiate dialysis or death at home as a competing event that may vary regionally. Likely because of reliance on patient self-report, the population prevalence of CKD according to BRFSS is much lower than the population prevalence of CKD defined using biochemical markers from the National Health and Nutrition Examination Survey (NHANES) [ 33 , 34 ]. This misclassification may also explain why we did not see stronger correlations between AKI-D incidence and CKD prevalence or AKI-D incidence and rate of hospitalization with CKD in unadjusted analyses, despite CKD being a very strong AKI risk factor.…”

Exploratory Cluster Analysis to Identify Patterns of Chronic Kidney Disease in the 500 Cities Project

“…The objective of this study was to determine how unhealthy behaviors, prevention measures, and outcomes related to CKD differ across US cities. We analyzed the cities at the state level, as literature shows that CKD prevalence and disease awareness differ across states (3). Understanding the state level differences may provide insight on policies and interventions to reduce CKD in urban settings.…”