Abstract
BackgroundPatient awareness of CKD and primary care provider (PCP) recognition of CKD are lower than for other chronic conditions. Understanding how patients may become aware of CKD is critical to their participation in healthy behaviors to slow CKD progression. We examined factors associated with the concordance of CKD awareness among patients and providers and hypothesized that concordance of CKD awareness would be influenced by social and demographic factors that impact communication, such as limited English proficiency (LEP) and health literacy.MethodsBetween July 2011 to July 2014, patients with CKD from three primary care clinics in a public healthcare delivery system were surveyed with questions regarding their health, including awareness of their CKD status. Chart review was performed to identify PCP recognition of CKD, defined as CKD listed anywhere in the problem list within nine months before patient enrollment into the study. We used logistic regression to determine the association between provider recognition and patient awareness of kidney disease among those patients with CKD, adjusting for patient demographics, co-morbidities, and provider training.ResultsThe study population (n = 152) had a mean age of 57.4 (SD 13), was 48.7% male and was racially/ethnically and linguistically diverse: 89.5% self-identified as Black, Hispanic, or Asian and 32.2% had LEP. Most patients had hypertension (89.5%) and diabetes (77.6%); mean eGFR was 66.1 ml/min/1.73m2 (SD 32.8). Positive concordance of CKD awareness was 42% (n = 64). Odds of positive concordance with their providers were much higher among patients with LEP compared to English speaking patients (adjusted odds ratio = 11.07, 95%CI 1.60–76.39).ConclusionsConcordance of CKD awareness among PCPs and their patients with CKD in one public delivery system was higher among patients with LEP. While speculative, this may be due to greater caution in provider communication about CKD with LEP patients.
Highlights
Patient awareness of Chronic Kidney Disease (CKD) and primary care provider (PCP) recognition of CKD are lower than for other chronic conditions
Status in one public healthcare delivery system, leveraging data collected for a study that examined different questions to ascertain CKD awareness among patients
CKD severity was associated with higher odds of positive concordance of CKD awareness
Summary
Patient awareness of CKD and primary care provider (PCP) recognition of CKD are lower than for other chronic conditions. Kidney disease is asymptomatic and requires awareness of risk factors in order to be tested and subsequently diagnosed with blood or urine tests This is likely one reason why CKD awareness among patients with mild CKD is very low, with national estimates of awareness among individuals with Stages 1– 2 CKD (defined by an estimated glomerular filtration rate [eGFR] > 60 ml/min/1.73m2 and abnormal levels albuminuria) of 3.2% [2]. Even awareness of CKD among patients with moderate-severe CKD (stages 3–4, defined by an eGFR 15–59 ml/min/1.73m2) is low, with national estimates of 10.5% [3] Contributing to this low awareness is suboptimal recognition of patients’ kidney disease among providers, as measured by documentation of CKD in the electronic health record. One study of 466 primary care practices geographically distributed in the U.S identified that PCP documentation of CKD among patients with lab-diagnosed CKD and type 2 was 12.1% [5]
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