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

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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 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.

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Author and article information

Journal

Journal ID (publisher-id): AJN

Journal ID (nlm-ta): Am J Nephrol

Journal ID (doi): 10.1159/issn.0250-8095

Title: American Journal of Nephrology

Publisher: S. Karger AG

ISSN (Print): 0250-8095

ISSN (Electronic): 1421-9670

Publication date Subscription-year: 2020

Publication date (Print): June 2020

Publication date (Electronic): 29 April 2020

Volume: 51

Issue: 6

Pages: 463-472

Affiliations

[_a] _aDivision of Nephrology, Department of Medicine, University of California, San Francisco, California, USA

[_b] _bKidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California, USA

[_c] _cSan Francisco Veterans Affairs Health Care System San Francisco, San Francisco, California, USA

[_d] _dDepartment of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA

[_e] _eWelch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

[_f] _fJohns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

[_g] _gDivision of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

[_h] _hDepartments of Medicine and Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA

[_i] _iDepartment of Epidemiology, Birmingham, Alabama, USA

[_j] _jDepartment of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA

[_k] _kDepartment of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA

[_l] _lDepartment of Public Health Sciences and Medicine, Chicago, Illinois, USA

[_m] _mDivision of Nephrology and Hypertension, Loyola University, Chicago, Illinois, USA

[_n] _nCricket Health, Inc., San Francisco, California, USA

[_o] _oCenter for Innovation in Access and Quality at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA

[_p] _pCenter for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California, San Francisco, California, USA

[_q] _qDepartment of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA

Author notes

*Sri Lekha Tummalapalli, MD, MBA, Department of Medicine, Division of Nephrology, 533 Parnassus Avenue, U404, San Francisco, CA 94143-0532 (USA), srilekha.tummalapalli@ucsf.edu

Article

Publisher ID: 507774 Other ID: Am J Nephrol 2020;51:463–472

DOI: 10.1159/000507774

PubMed ID: 32349001

SO-VID: 848cf1c4-4bf7-4bb4-b9a7-834cf0329510

License:

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 02 March 2020

Date accepted : 06 April 2020

Page count

Tables: 4, Pages: 10

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