TY - JOUR
T1 - Chronic Kidney Disease Awareness and Longitudinal Health Outcomes
T2 - Results from the REasons for Geographic and Racial Differences in Stroke Study
AU - Tummalapalli, Sri Lekha
AU - Vittinghoff, Eric
AU - Crews, Deidra C.
AU - Cushman, Mary
AU - Gutiérrez, Orlando M.
AU - Judd, Suzanne E.
AU - Kramer, Holly J.
AU - Peralta, Carmen A.
AU - Tuot, Delphine S.
AU - Shlipak, Michael G.
AU - Estrella, Michelle M.
N1 - Funding Information:
This research project is supported by cooperative agreement U01 NS041588 co-funded by the National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute on Aging, National Institutes of Health, and Department of Health and Human Service. This work is also supported by grant R01 HL080477 funded by the National Heart, Lung, and Blood Institute within the National Institutes of Health.
Funding Information:
This research project is supported by cooperative agreement U01 NS041588 co-funded by the National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute on Aging, National Institutes of Health, and Department of Health and Human Service. This work is also supported by grant R01 HL080477 funded by the National Heart, Lung, and Blood Institute within the National Institutes of Health.
Funding Information:
The content is solely the responsibility of the authors and does not necessarily represent the official views of the NINDS or the National Institute on Aging. Representatives of the NINDS were involved in the review of the manuscript but were not directly involved in the collection, management, analysis, or interpretation of the data. The authors thank the other investigators, the staff, and the participants of the REGARDS study for their valuable contributions. A full list of participating REGARDS investigators and institutions can be found at: https://www.uab.edu/soph/regardsstudy/Dr. Sri Lekha Tummalapalli is supported by grant F32 DK122627 funded by the National Institute of Diabetes and Digestive and Kidney Diseases within the National Institutes of Health and the Jonathan A. Showstack Career Advancement Award in Health Policy/Health Services Research at the UCSF Philip R. Lee Institute for Health Policy Studies.
Publisher Copyright:
© 2020 S. Karger AG, Basel. Copyright: All rights reserved.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - 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.
AB - 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.
KW - Awareness
KW - Chronic kidney disease
KW - Patient education
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U2 - 10.1159/000507774
DO - 10.1159/000507774
M3 - Article
C2 - 32349001
AN - SCOPUS:85084397273
VL - 51
SP - 463
EP - 472
JO - American Journal of Nephrology
JF - American Journal of Nephrology
SN - 0250-8095
IS - 6
ER -