TY - JOUR
T1 - CKD Awareness Among US Adults by Future Risk of Kidney Failure
AU - Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team
AU - Chu, Chi D.
AU - McCulloch, Charles E.
AU - Banerjee, Tanushree
AU - Pavkov, Meda E.
AU - Burrows, Nilka R.
AU - Gillespie, Brenda W.
AU - Saran, Rajiv
AU - Shlipak, Michael G.
AU - Powe, Neil R.
AU - Tuot, Delphine S.
AU - Shahinian, Vahakn
AU - Heung, Michael
AU - Gillespie, Brenda
AU - Morgenstern, Hal
AU - Herman, William
AU - Zivin, Kara
AU - Bragg-Gresham, Jennifer
AU - Steffick, Diane
AU - Han, Yun
AU - Zhang, Xiaosong
AU - Li, Yiting
AU - Kurtz, Vivian
AU - Wyncott, April
AU - Powe, Neil
AU - Hsu, Chi yuan
AU - Crews, Deidra
AU - Hsu, Raymond
AU - Johansen, Kirsten
AU - Shlipak, Michael
AU - Canela, Janet
AU - Burrows, Nilka Ríos
AU - Eberhardt, Mark
AU - Mondesire, Juanita
AU - Patel, Priti
AU - Pavkov, Meda
AU - Rolka, Deborah
AU - Saydah, Sharon
AU - Shrestha, Sundar
AU - Waller, Larry
N1 - Funding Information:
University of Michigan: Rajiv Saran (PI), Vahakn Shahinian, Michael Heung, Brenda W. Gillespie, Hal Morgenstern, William Herman, Kara Zivin, Jennifer Bragg-Gresham, Diane Steffick, Yun Han, Xiaosong Zhang, Yiting Li, Vivian Kurtz, April Wyncott; University of California, San Francisco: Neil R. Powe (PI), Tanushree Banerjee, Delphine S. Tuot, Chi-yuan Hsu, Charles E. McCulloch, Deidra Crews, Raymond Hsu, Kirsten Johansen, Michael Shlipak, Janet Canela; Centers for Disease Control and Prevention: Nilka Ríos Burrows (Technical Advisor), Mark Eberhardt, Juanita Mondesire, Priti Patel, Meda Pavkov, Deborah Rolka, Sharon Saydah, Sundar Shrestha, Larry Waller. Chi D. Chu, MD, Charles E. McCulloch, PhD, Tanushree Banerjee, PhD, Meda E. Pavkov, MD, PhD, Nilka R. Burrows, MPH, Brenda W. Gillespie, PhD, Rajiv Saran, MD, Michael G. Shlipak, MD, MPH, Neil R. Powe, MD, MPH, MBA, and Delphine S. Tuot, MDCM, MAS. Research idea and study design: CDC, TB, MEP, NRB, BWG, RS, MGS, DST, NRP; data acquisition: CDC; data analysis/interpretation: CDC, CEM, DST; statistical analysis: CDC, CEM, DST; supervision or mentorship: DST, NRP. Each author contributed important intellectual content during manuscript drafting or revision, accepts personal accountability for the author's own contributions, and agrees to ensure that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. This investigation was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under the Ruth L. Kirschstein National Research Service Award 1F32DK122629-01, and by the Supporting, Maintaining and Improving the Surveillance System for Chronic Kidney Disease in the U.S. Cooperative Agreement Number, U58 DP006254, funded by the Centers for Disease Control and Prevention. The funders of this study had no role in study design; collection, analysis, and interpretation of data; writing the report; and the decision to submit the report for publication. The authors declare that they have no relevant financial interests. The findings and conclusions in this report are solely those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the Department of Health and Human Services. An earlier version of this work was presented as a poster at the American Society of Nephrology Kidney Week, November 5-10, 2019, Washington, DC. Received September 19, 2019. Evaluated by 2 external peer reviewers and a statistician, with direct editorial input from an International Editor, who served as Acting Editor-in-Chief. Accepted in revised form January 6, 2020. The involvement of an Acting Editor-in-Chief was to comply with AJKD's procedures for potential conflicts of interest for editors, described in the Information for Authors & Journal Policies.
Funding Information:
This investigation was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under the Ruth L. Kirschstein National Research Service Award 1F32DK122629-01, and by the Supporting, Maintaining and Improving the Surveillance System for Chronic Kidney Disease in the U.S., Cooperative Agreement Number, U58 DP006254 , funded by the Centers for Disease Control and Prevention . The funders of this study had no role in study design; collection, analysis, and interpretation of data; writing the report; and the decision to submit the report for publication.
Publisher Copyright:
© 2020 National Kidney Foundation, Inc.
PY - 2020/8
Y1 - 2020/8
N2 - Rationale & Objective: Persons with chronic kidney disease (CKD) are often unaware of their disease status. Efforts to improve CKD awareness may be most effective if focused on persons at highest risk for progression to kidney failure. Study Design: Serial cross-sectional surveys. Setting & Participants: Nonpregnant adults (aged ≥20 years) with CKD glomerular filtration rate categories 3-4 (G3-G4) who participated in the National Health and Nutrition Examination Survey from 1999 to 2016 (n = 3,713). Predictor: 5-year kidney failure risk, estimated using the Kidney Failure Risk Equation. Predicted risk was categorized as minimal (<2%), low (2%-<5%), intermediate (5%-<15%), or high (≥15%). Outcome: CKD awareness, defined by answering “yes” to the question “Have you ever been told by a doctor or other health professional that you had weak or failing kidneys?” Analytical Approach: Prevalence of CKD awareness was estimated within each risk group using complex sample survey methods. Associations between Kidney Failure Risk Equation risk and CKD awareness were assessed using multivariable logistic regression. CKD awareness was compared with awareness of hypertension and diabetes during the same period. Results: In 2011 to 2016, unadjusted CKD awareness was 9.6%, 22.6%, 44.7%, and 49.0% in the minimal-, low-, intermediate-, and high-risk groups, respectively. In adjusted analyses, these proportions did not change over time. Awareness of CKD, including among the highest risk group, remains consistently below that of hypertension and diabetes and awareness of these conditions increased over time. Limitations: Imperfect sensitivity of the “weak or failing kidneys” question for ascertaining CKD awareness. Conclusions: Among adults with CKD G3-G4 who have 5-year estimated risks for kidney failure of 5%-<15% and ≥15%, approximately half were unaware of their kidney disease, a gap that has persisted nearly 2 decades.
AB - Rationale & Objective: Persons with chronic kidney disease (CKD) are often unaware of their disease status. Efforts to improve CKD awareness may be most effective if focused on persons at highest risk for progression to kidney failure. Study Design: Serial cross-sectional surveys. Setting & Participants: Nonpregnant adults (aged ≥20 years) with CKD glomerular filtration rate categories 3-4 (G3-G4) who participated in the National Health and Nutrition Examination Survey from 1999 to 2016 (n = 3,713). Predictor: 5-year kidney failure risk, estimated using the Kidney Failure Risk Equation. Predicted risk was categorized as minimal (<2%), low (2%-<5%), intermediate (5%-<15%), or high (≥15%). Outcome: CKD awareness, defined by answering “yes” to the question “Have you ever been told by a doctor or other health professional that you had weak or failing kidneys?” Analytical Approach: Prevalence of CKD awareness was estimated within each risk group using complex sample survey methods. Associations between Kidney Failure Risk Equation risk and CKD awareness were assessed using multivariable logistic regression. CKD awareness was compared with awareness of hypertension and diabetes during the same period. Results: In 2011 to 2016, unadjusted CKD awareness was 9.6%, 22.6%, 44.7%, and 49.0% in the minimal-, low-, intermediate-, and high-risk groups, respectively. In adjusted analyses, these proportions did not change over time. Awareness of CKD, including among the highest risk group, remains consistently below that of hypertension and diabetes and awareness of these conditions increased over time. Limitations: Imperfect sensitivity of the “weak or failing kidneys” question for ascertaining CKD awareness. Conclusions: Among adults with CKD G3-G4 who have 5-year estimated risks for kidney failure of 5%-<15% and ≥15%, approximately half were unaware of their kidney disease, a gap that has persisted nearly 2 decades.
KW - CKD awareness
KW - Chronic kidney disease (CKD)
KW - albuminuria
KW - disease management
KW - estimated glomerular filtration rate (eGFR)
KW - health literacy
KW - kidney failure prevention
KW - nationally representative survey
KW - patient empowerment
KW - public health
KW - renal function
KW - renal insufficiency
KW - self-care
KW - urinary albumin-creatinine ratio (UACR)
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U2 - 10.1053/j.ajkd.2020.01.007
DO - 10.1053/j.ajkd.2020.01.007
M3 - Article
C2 - 32305206
AN - SCOPUS:85083254157
VL - 76
SP - 174
EP - 183
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
SN - 0272-6386
IS - 2
ER -