Awareness Of Chronic Kidney Disease Research Articles

Access to chronic kidney disease (CKD) care: Its barriers and facilitators in a community development block in Purba Bardhaman, West Bengal: A qualitative study.

Chronic kidney disease (CKD), a leading public health problem, has potential risks and serious implications on the health of individuals and society at large. Few studies explored the factors that influence access to CKD care at the community level in rural areas of West Bengal. A qualitative study was planned among key stakeholders to explore their views and experiences and to identify the barriers and potential facilitators that influence access to CKD care at the primary care level. Total 23 stakeholders participated in the study. Seventeen in-depth interviews (IDIs) were conducted on a purposive sample of stakeholders (CKD patients, healthcare providers (HCPs) and health planners) and one focus group discussion (FGD) among six community health workers. The audio-recorded interviews were transcribed verbatim. The Lévesque's framework for access to care as modified by Jodie Bailie et al. was employed to construct interview guides and structure the initial codes. Thematic analysis was undertaken using QSR NVivo version 11 using both inductive and deductive approaches. The major barriers to CKD care at patient level were poor knowledge and awareness of CKD and at the health system level was shortage of skilled staffs, diagnostics and medicines and fragmented referrals. The potential facilitators identified were educational activities to increase the awareness of CKD among HCPs and patients; provision of CKD-related supplies and a system-level approach to care coordination along with m-health-based care. Targeted CKD screening programs and CKD specific trainings may improve awareness of CKD. Additionally, stronger primary care infrastructure, availability of essential drugs and diagnostics and creating an efficient referral process for the quality CKD care are the need of the hour.

Retracted: Measuring the Awareness of Chronic Kidney Disease (CKD) with Environmental Evaluation among Adult Diabetic Patients in Hail Region, Saudi Arabia.

[This retracts the article DOI: 10.1155/2022/4505345.].

#5047 DIABETES AND CHRONIC KIDNEY DISEASE IN TURKEY (DIAKIT): THE STUDY ON CHRONIC KIDNEY DISEASE IN DIABETES MELLITUS PATIENTS IN THE CAPPADOCIA COHORT

Abstract Background and Aims Diabetes mellitus (DM) is the most common cause of chronic kidney disease (CKD) [1]. The prevalence of CKD is therefore increasing worldwide with increasing prevalence of DM [1]. Among those with DM, CKD prevalence varies widely between countries. The actual prevalence of CKD in patients with DM in Turkey is unknown. This study aimed to determine frequency of CKD among diabetic patients of Cappadocia cohort and patients’ awareness about the disease. Method A total of 1591 diabetic patients from the Cappadocia cohort were invited to this cross-sectional study. A trained study team administered a questionnaire for patients’ medical history, knowledge, attitudes, and awareness of the disease and measured patients’ blood pressures (BPs) at least three times using an automated device. Serum creatinine was measured and spot urine albumin/creatinine ratio (ACR) measurements were performed for three consecutive days. A diagnosis of CKD was established if glomerular filtration rate (GFR)is <60 mL/min or ACR is >30 mg/g. Results The mean age of the patients was 63±10 years. Overall, 60.9% patients were obese (body mass index ≥30 kg/m2), and 70% patients were hypertensive. HbA1c was analyzed in 98.2% of the patients; HbA1c was <7% in 27.4%, ≥7%-≤8% in 20.8%, >8%-≤9% in 17.7%, and >9% in 34.1% of the patients. of 1535 patients with blood and urine analyses, 231 of 1008 (22.9%) females and 154 of 527 (29.2%) males had CKD (P = .007). Among patients with GFR values, 11.4% had a GFR of <60 mL/min and 88.6% had a GFR of ≥60 mL/min. Among 1544 patients with ACR measurements, 18.2% had values ≥30 mg/g and 4.4% had values ≥300 mg/g. CKD was detected in 385 (25.1%) of 1535 patients with both GFR and ACR values (Figure 1). of these patients, 28.1% had Stage 1, 25.7% had Stage 2, 32.5% had Stage 3A, 11.2% had Stage 3B and 2.6% had Stage 4 or 5 CKD. Excluding two patients with missing data, 36 of 383 CKD patients (9.4%) knew that they had CKD. In the logistic regression analysis, old age (OR=1.05, 95% CI 1.03-1.07; p<0.001), male sex (OR=2.11, 95% CI 1.43-3.12; p<0.001), duration of DM (OR=1.03, 95% CI 1.00-1.05; P = .022), morbid obesity (OR=3.58, 95% CI 1.28-10.03, P = .015), a CRP level of >5 mg/L (OR=1.60, 95% CI 1.12-2.27; P = .009), a triglyceride level of ≥150 mg/L (OR=1.74, 95% CI 1.24-2.45; P = .002), and grade 3 hypertension (OR=2.13, 95% CI 1.02-4.44; P = .043) were found to be significantly associated with an increased risk of CKD in patients with DM. Conclusion In the present study, CKD prevalence among diabetic patients in Turkey was 25.1%. Overall, 53.8% of the patients with CKD had a GFR of ≥60 mL/min although they had an ACR of ≥30 mg/day; that is, if albuminuria was not studied, this subgroup of patients would have been considered to have normal kidney function according to GFR. The awareness of CKD was found to be quite low in the patients. Therefore, periodic screening of diabetic patients should always include urinalysis, particularly ACR, as well as serum creatinine, fasting blood glucose and HbA1c.

Chronic kidney disease awareness and its determinants in middle-aged and older Japanese adults: Observations from a 5-year follow-up of the Uonuma cohort study.

Despite global efforts in public health campaigns concerning chronic kidney disease (CKD), awareness of the condition remains low. We evaluated CKD awareness and related factors to identify an effective way to raise awareness. This study assessed laboratory-confirmed CKD and self-reported CKD using a population-based cohort (baseline from 2012 to 2014, age ≥40 years) in Niigata, Japan. Self-reported CKD was obtained at a 5-year follow-up survey and laboratory-confirmed CKD was diagnosed when an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 or dipstick urinary protein ≥1+ was observed in at least two health check-ups during the 5-year period. CKD awareness was defined as a match between laboratory-confirmed and self-reported CKD. The association between characteristics and CKD awareness was tested by multivariable logistic regression analysis with adjustment for eGFR and other potential confounders. The analytic population comprised 7472 individuals (mean age, 65.6 years old, 51.2% women) and 19.4% with laboratory-confirmed CKD. The sensitivity and specificity of the survey question concerning self-reported CKD were 12.4% and 98.2%, respectively. Among the participants with laboratory-confirmed CKD, significant factors associated with CKD awareness were male sex (adjusted odds ratio [95% confidence interval], 1.81 [1.27, 2.59]), a history of urinary tract stone (1.86 [1.06, 3.26]), age (0.97 [0.95, 0.99]), and married status (0.66 [0.44, 0.99]). Our findings suggest that known lifestyle-related diseases that could cause CKD are not associated with CKD awareness independently of kidney function and that a sex-dependent approach may help to raise CKD awareness in community-dwelling Japanese adults.

Chronic kidney disease prevalence and awareness in middle age and young old: Regional comparative study in Japan.

Patients with chronic kidney disease are not aware of the illness because of its asymptomatic nature, but the association of disease progression and awareness in general population has not been sufficiently analysed on a large scale. We analysed the nationwide annual specific health checkup covering more than a half of the overall population at aged 40-74 in Japan, approximately 29.4 million people as of 2018, in combination with parameters to represent regional characteristics. The rate of the examinees with kidney dysfunction, an estimated glomerular filtration rate of <45 mL/min/1.73 m2 , was 1.0%, while that of examinees with of dipstick proteinuria ≥ (+) was 3.7%. Next, we conducted a regional comparative study on 335 medical administrative areas divided in the country. The regional rate of examinees aged 65-74 over the total examinees was positively correlated with the prevalence of kidney dysfunction (r = 0.72, p < .0001). Additionally, the mean rate of examinees aware of their 'chronic kidney failure' was 0.6%, and the awareness rate was correlated with the prevalence of both kidney dysfunction (r = 0.36, p < .001) and positive dipstick proteinuria (r = 0.31, p < .001) in those aged 65-74 at the regional level. Association of nephrology care resources with the prevalence or awareness was unclear at the regional level. We found a regional association of chronic kidney disease prevalence and awareness in a recent young old population in Japan. Further studies are needed to evaluate the patient screen and referral at the individual level.

Chronic kidney disease awareness and updates on the management of diabetic kidney disease

AbstractThe prevalence of chronic kidney disease (CKD) is rising worldwide and is a major contributor to morbidity and mortality. It is estimated to affect over 800 million people globally.CKD and its complications carry a substantial financial burden to the NHS in both primary and secondary care. The lack of public awareness of CKD and its complications leads to a reduction in planned follow‐up attendance; clinician awareness of the biomarkers of CKD and progression is still lacking. Measures to improve awareness are needed.Diabetes mellitus remains the single most common cause of progressive renal impairment and over 40% of patients with diabetes will develop diabetic kidney disease in their lifetime. A multidisciplinary approach to management and early intervention are therefore key to halt the progress of diabetic kidney disease. The National Institute for Health and Care Excellence has set clear guidelines for the management of diabetic kidney disease, highlighting newer therapeutic agents like SGLT2 inhibitors. New guidelines are also in place for referral to secondary care involving the Kidney Failure Risk Equation, as it identifies patients at increased risk of progressing to end stage kidney disease.Without robust measures for early detection and management of CKD, progression to kidney failure may occur, exacerbating the increase in cardiovascular disease, premature deaths and poor quality of life. This article is a call to action for the optimal and timely management of CKD. Copyright © 2023 John Wiley &amp; Sons.

Investigating Knowledge Level, Awareness, Risk Factors and Preventive practices of Patients Regarding Ckd in Northern Ghana

Background: Chronic Kidney Disease (CKD) is a major global health problem. CKD is one of the most common complications of diabetes mellitus and hypertension and carries a risk of cardiovascular morbidity and mortality and usually progress to end-stage kidney disease. Objectives: The main objective of the study was to assess the knowledge, awareness and prevalence of chronic kidney disease among patients seeking healthcare at the Tamale Central Hospital Methodology: A descriptive cross-sectional study was carried out and a total of 260 respondents were selected by a systematic random sampling method and structured questionnaire were used to collect data from the respondent. Consent was sought from each selected participant, privacy and confidentiality was observed during the data collection. Data was analyzed using SPSS version 26.0. Results: Findings from this study discovered that, 96 (36.9%) of the respondents were between 25-30 years of age. Majority, 165 (63.5%) of the respondents were females, whiles 217 (83.5%) of the respondents have heard about chronic kidney disease. Regarding the source of information, majority 92 (35.4%) of the respondents heard about chronic kidney disease from healthcare workers. Majority, 212 (81.5%) of the respondents admitted it’s true that chronic kidney disease is a reduction in its ability to remove waste, 240 (92.3%) said its true chronic kidney disease means an infection of the kidney, 229 (88.1%) said its true chronic kidney disease means damage to the kidney. About 198 (76.2%) of the respondents believed drinking too little water can results in chronic kidney disease, almost all, 247 (95.0%) of the respondnets believe smoking can result into chronic kidney disease, also, majority 209 (80.4%) of the respondents believe untreated hypertension can result in CKD. Conclusion: The research question what is the knowledge level, awareness, risk factors and preventive practices of patients regarding CKD, was answered as the findings above speak to these questions. The burden of CKD remains serious and unacceptably high, appropriate preventive measures should be implemented to reduce kidney disease in Ghana and it is suggested that future research should look at a qualitative research method in order to spell out a lot of the information that respondents in this study were not able to give in detail due to the restrictions on the questionnaire used. A future study could seek to include more than one healthcare facility and increase the sample size.

Prevalence of Chronic Kidney Disease in China

To our knowledge, there has been no update on the prevalence of chronic kidney disease (CKD) in China since 2012. To provide periodic nationwide data on the prevalence of CKD and the associated behavioral and metabolic risk factors in China. This nationally representative cross-sectional study included data from 176 874 adults from all 31 provincial-level administrative divisions in mainland China, as reported in the sixth China Chronic Disease and Risk Factor Surveillance conducted from August 2018 to June 2019. Data analysis was performed in 2021 to 2022. Serum creatinine, urinal creatinine, and urine albumin were measured for all participants. Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine using the CKD-EPI equation. The primary outcome was weighted prevalence of CKD in the overall population and different strata, defined as presence of impaired kidney function (eGFR of <60 mL/min/1.73m2) or albuminuria (urine albumin-to-creatinine ratio of ≥30 mg/g). Secondary outcomes were awareness of CKD and control of comorbidities. Logistic regression was used to examine the association of sociodemographic characteristics, behavioral and dietary habits, physical activity, and comorbidities with CKD. A total of 184 876 participants contributed data to this study, and of the 176 874 adults 18 years and older with measurements of eGFR and urine albumin-to-creatinine ratio in 2018 to 2019, the mean age was 43.8 years and the weighted proportion of women was 44.6%. The estimated prevalence of CKD, impaired kidney function, and albuminuria were 8.2%, 2.2%, and 6.7%, respectively. A higher prevalence of CKD was observed in the subgroups characterized by older age, female gender, non-Han ethnicity, residency of rural or north and central parts of China, receiving less education or lower income, former smoking, no alcohol drinking, lacking physical activity, and presence of risk factors such as obesity, hypertension, diabetes, dyslipidemia, and self-reported cardiovascular disease. Among the adults with CKD, 73.3%, 25.0%, and 1.8% were at stage 1 to 2, 3, and 4 to 5, respectively, and the awareness of CKD was 10.0%. This cross-sectional study found a weighted estimated of 82 million adults with CKD in China in 2018 to 2019. The prevalence appears to have decreased by 30% in the past decade. Better environmental protection, integration of CKD into the national public health surveillance program, and control of common CKD comorbidities appear to be associated with reducing the disease burden of CKD.

Trends in chronic kidney disease awareness and related clinical and demographic characteristics from 1998 to 2018 in Koreans.

Chronic kidney disease (CKD) is a common and growing problem in Korea. Although CKD awareness is the first step in CKD management, evidence indicates that the rate of CKD awareness is unsatisfactory worldwide. Thus, we investigated the trend of CKD awareness for CKD patients in Korea. Through analyzing data from the Korea National Health and Nutrition Examination Survey (KNHAES) in 1998, 2001, 2007-2008, 2011-2013, and 2016-2018, we evaluated the rate of CKD awareness according to CKD stage in each phase of KNHANES. Clinical and sociodemographic characteristics were compared between CKD awareness and unawareness groups. Multivariate regression analysis was used to calculate the adjusted odds ratio (OR) and 95% confidence interval (CI) for CKD awareness [adjusted OR (95% CI)] in given socioeconomic and clinical factors. The overall awareness rate of CKD stage 3 remained at low levels of less than 6.0% through all phases of KNHAES except that of V-VI. In particular, CKD awareness was remarkably low in stage 3 CKD. Compared to CKD unawareness group, CKD awareness group was of young age, higher income, higher education, more medical aid, higher prevalence of comorbidities, and more advanced CKD. In multivariate analysis, CKD awareness was significantly associated with age [0.94 (0.91-0.96)], medical aid [3.23 (1.44-7.28)], proteinuria [0.27 (0.11-0.69)], and renal function [0.90 (0.88-0.93)]. CKD awareness has been consistently low in Korea. This trend warrants the special endeavor to promote CKD awareness in Korea.

Knowledge, Attitudes and practices to detect and prevent Chronic Kidney Disease among hypertensive patients at primary and cardiology clinics in the Emirates of Ajman and Sharjah, UAE

The alarming association of Hypertension and Chronic Kidney Disease (CKD) has urged severalresearch to investigate the level of knowledge, attitudes and practices (KAP) of CKD among hypertensive patients,yet none was donein the United Arab Emirates (UAE). This study aimed to assess the KAP concerning CKDand their relation to the socio-demographic and clinical factors of hypertensive patients. A cross-sectional study was conducted among hypertensive patients attending cardiology and primary clinics in the Emirates of Ajman and Sharjah in the UAE. A validated face-to-face questionnairewas conductedfrom December 2019 until February 2020. The questionnaire consisted of three sections: socio-demographic characteristics, clinical characteristics and the KAP scales. Multiple linear regression was used to analyze the relation of the KAP scores to the sociodemographic and clinical characteristics.A total of 200 patients with hypertension consented to participate. The mean age was 49.97(±9.67) years. The percentages of knowledge, attitudes and practices scores about prevention and detection of CKD were 50.8%, 66.6% and 71.7% respectively.A higherknowledge score wasrelated significantly to female gender, urban residency and university level education.Cardiology clinic setting was the only significant factor related to higher attitudes score. Furthermore, higher knowledge score, higher attitudesscoreand urban residencywas significantly related tohigher practices score.Hypertensive patients require more attentionto implement CKD awareness programs that could possibly improve theirpreventive practices.

Prevalence, Risk Factors, and Awareness of Chronic Kidney Disease among Diabetes Mellitus and Hypertensive Individuals at the Buea Regional Hospital, Cameroon

Background: Kidney failure, cardiovascular disease, and early mortality are just a few of the major negative effects of chronic renal disease, a serious global health issue. The considerable financial and public health burden associated with chronic kidney disease can be lessened by raising awareness and adopting better practices for its impact, prevention, and early identification. Objective: In this study, individuals with hypertension and diabetes were evaluated for their knowledge of chronic kidney disease, its prevalence, and its risk factors. Method: It was a hospital-based cross-sectional study conducted on adult (>18 years) patients with diabetes mellitus and hypertension. Each participant provided written informed consent before having their data collected through interviews, medical information, and blood samples for CKD screening. The CKD epidemiology collaboration (CKD-EPI) equation was used to calculate the glomerular filtration rate (GFR) from serum creatinine, and CKD was determined using the estimated GFR (e-GFR). To find independent CKD factors, multivariate logistic regression was employed, with a p-value of 0.05 being regarded as statistically significant. This was accomplished using SPSS (Statistical Program for Social Sciences) version 22.0, IBM Corp., Armonk, NY. Result: A total of 156 participants took part in the study among which 95 (60.9%) were male, most of the participants 82 (52.6%) were aged between 51 - 70 years (mean 59.42 ± 11.007), 76 (48.7%) were unemployed and 97 (62.2%) were single. Overall, the knowledge score of participants on CKD was 65.4% for good knowledge and 34.6% for poor or inadequate knowledge of CKD. More than half of the participants (60%) had chronic kidney disease. Among these, the greatest proportion of CKD patients were those who were hypertensive (88.2%) followed by those who were both hypertensive and diabetic (70.7%). Conclusion: There is poor management of CKD in the South West Region of Cameroon which has contributed greatly to the progression of CKD and increases in the mortality rate.

A Health Survey-Based Prediction Equation for Incident CKD.

Prediction tools that incorporate self-reported health information could increase CKD awareness, identify modifiable lifestyle risk factors, and prevent disease. We developed and validated a survey-based prediction equation to identify individuals at risk for incident CKD (eGFR <60 ml/min per 1.73 m2), with and without a baseline eGFR. A cohort of adults with an eGFR ≥70 ml/min per 1.73 m2 from Ontario, Canada, who completed a comprehensive general population health survey between 2000 and 2015 were included (n=22,200). Prediction equations included demographics (age, sex), comorbidities, lifestyle factors, diet, and mood. Models with and without baseline eGFR were derived and externally validated in the UK Biobank (n=15,522). New-onset CKD (eGFR <60 ml/min per 1.73 m2) with ≤8 years of follow-up was the primary outcome. Among Ontario individuals (mean age, 55 years; 58% women; baseline eGFR, 95 (SD 15) ml/min per 1.73 m2), new-onset CKD occurred in 1981 (9%) during a median follow-up time of 4.2 years. The final models included lifestyle factors (smoking, alcohol, physical activity) and comorbid illnesses (diabetes, hypertension, cancer). The model was discriminating in individuals with and without a baseline eGFR measure (5-year c-statistic with baseline eGFR: 83.5, 95% confidence interval [CI], 82.2 to 84.9; without: 81.0, 95% CI, 79.8 to 82.4) and well calibrated. In external validation, the 5-year c-statistic was 78.1 (95% CI, 74.2 to 82.0) and 66.0 (95% CI, 61.6 to 70.4), with and without baseline eGFR, respectively, and maintained calibration. Self-reported lifestyle and health behavior information from health surveys may aid in predicting incident CKD. This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast.aspx?p=CJASN&e=2023_01_10_CJN05650522.mp3.

Prevalence of Chronic Kidney Disease Among Diabetes and Hypertensive Patients in a Teaching Hospital in Ekiti State, Southwest Nigeria

Introduction: Chronic kidney disease (CKD) is a growing public health problem associated with enormous economic burdens, reduced quality of life, and untimely deaths, predominantly in developing countries. Aims: The study determines the prevalence and risk factors for CKD among diabetes and hypertensive patients in a teaching hospital in Ekiti State. Methods: Descriptive and cross-sectional research designs were employed using a quantitative strategy. Two hundred (200) randomly selected participants participated in the study. Socio-demographic data, awareness, and risk factors for CKD were determined using a standardized questionnaire, while CKD prevalence was investigated with biophysical measurements and laboratory investigations. Descriptive analyses were used to answer the research questions, while inferential statistics were used to test hypotheses at a significant level of p &lt; 0.05. Results: Findings revealed that 50% and 57.1% of the diabetics and hypertensives were above 60 years, 36.7% of the people with diabetes had comorbidity, while only 2% and 3.1% of diabetics and hypertensives participants had a family history of CKD. The study revealed that the respondents' level of awareness of CKD was inadequate. Major risk factors of CKD identified among the respondents were already diagnosed with diabetes and hypertension, age above 60 years (50% and 57.1%), herbal concoction (77.7% and 73.5%), and NSAID (74.5% and 78.6%). The prevalence of CKD for people with diabetes was 39.8%, while 57.1% for hypertensives. There was a significant relationship between respondents’ level of education and awareness of CKD (X2 =44.20, p=&lt;0.001). The prevalence of CKD among the studied population was high. Conclusion: Efforts should be intensified by nurses and all other stakeholders on awareness and prevention programs for CKD. Furthermore, the promotion of patients’ satisfaction with the quality of healthcare services should be the goal to promote positive health outcomes.

Monitoring and management of chronic kidney disease in ambulatory care – analysis of clinical and claims data from a population-based study

BackgroundAlthough chronic kidney disease (CKD) is highly prevalent in the general population, little research has been conducted on CKD management in ambulatory care.Objective was to assess management and quality of care by evaluating CKD coding in ambulatory care, patient diagnosis awareness, frequency of monitoring and whether appropriate patients are referred to nephrology.MethodsClinical data from the population-based cohort Study of Health in Pomerania (SHIP-START) were matched with claims data of the Association of Statutory Health Insurance Physicians. Quality of care was evaluated according international and German recommendations.ResultsData from 1778 participants (56% female, mean age 59 years) were analysed. 10% had eGFR < 60 ml/min/1.73m2 (mean age 74 years), 15% had albuminuria. 21% had CKD as defined by KDIGO. 20% of these were coded and 7% self-reported having CKD. Coding increased with GFR stage (G3a 20%, G3b 61%, G4 75%, G5 100%). Serum creatinine and urinary dip stick testing were billed in the majority of all participants regardless of renal function. Testing frequency partially surpassed recommendations. Nephrology consultation was billed in few cases with stage G3b-G4.ConclusionCKD coding increased with stage and was performed reliably in stages ≥ G4, while CKD awareness was low. Adherence to monitoring and referral criteria varied, depending on the applicability of monitoring criteria. For assessing quality of care, consent on monitoring, patient education, referral criteria and coordination of care needs to be established, accounting for patient related factors, including age and comorbidity.Trial registrationThis study was prospectively registered as DRKS00009812 in the German Clinical Trials Register (DRKS).

A CKD Awareness Campaign and mHealth Education to Improve Knowledge and Quality of Life Among CKD Patients in Bangladesh: A Randomized Controlled Trial

A CKD Awareness Campaign and mHealth Education to Improve Knowledge and Quality of Life Among CKD Patients in Bangladesh: A Randomized Controlled Trial

Predictors of CKD Awareness in Middle-Aged and Older Community-Dwelling Japanese Adults

Predictors of CKD Awareness in Middle-Aged and Older Community-Dwelling Japanese Adults

Overcoming barriers to implementing new guideline-directed therapies for chronic kidney disease.

For the first time in many years, guideline-directed drug therapies have emerged that offer substantial cardiorenal benefits, improved quality of life and longevity in patients with chronic kidney disease (CKD) and type 2 diabetes. These treatment options include sodium-glucose cotransporter-2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists and glucagon-like peptide-1 receptor agonists. However, despite compelling evidence from multiple clinical trials, their uptake has been slow in routine clinical practice, reminiscent of the historical evolution of angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker use. The delay in implementation of these evidence-based therapies highlights the many challenges to optimal CKD care, including: (i) clinical inertia; (ii) low CKD awareness; (iii) suboptimal kidney disease education among patients and providers; (iv) lack of patient and community engagement; (v) multimorbidity and polypharmacy; (vi) challenges in the primary care setting; (vii) fragmented CKD care; (viii) disparities in underserved populations; (ix) lack of public policy focused on health equity; and (x) high drug prices. These barriers to optimal cardiorenal outcomes can be ameliorated by a multifaceted approach, using the Chronic Care Model framework, to include patient and provider education, patient self-management programs, shared decision making, electronic clinical decision support tools, quality improvement initiatives, clear practice guidelines, multidisciplinary and collaborative care, provider accountability, and robust health information technology. It is incumbent on the global kidney community to take on a multidimensional perspective of CKD care by addressing patient-, community-, provider-, healthcare system- and policy-level barriers.

Determinants of Chronic Kidney Disease among Diabetes Mellitus Patients at Gatundu Level 5 Hospital, Kiambu County, Kenya

The prevalence of chronic kidney disease (CKD) is rising alarmingly throughout the world, and it is one of the major public health menace due to the significant morbidity and mortality it is associated with. The burden of CKD inexplicably affects low-income nations like Kenya, where the two main public health concerns for the CKD growth rate are hypertension and diabetes mellitus. The aim of this study was to identify the determinants of chronic kidney disease diabetes mellitus patients and also assess their awareness, perspectives and prevalence of CKD. A hospital based cross-sectional study design was conducted at a rural hospital in central Kenya among adult (≥18 years) diabetes mellitus patients. Sample size was determined using Yamane Taro formula. Informed written consent was obtained from each participant and data was collected by interview and chart review; Glomerular filtration rate (GFR) was estimated from serum creatinine using modification of diet in renal disease (MDRD) formula, while CKD was defined as eGFR of less than 60mls/min/1.73m2 for more than three months. Multivariate logistic regression was used to identify independent determinants of CKD and a p-value of &lt;0.05 was considered to be statistically significant. Majority of the participants (43.42%) were aged between50-60 years and 95 (62.5%) of them were females. Participants with history of high blood pressure had a 129.4 %(AOR;1.29495% CI, 2.401-.698) risk of having CKD, while those who did not perform physical exercises were found to be 123.3% (AOR 1.233, 95% CL,1.889-.805) times more likely to have CKD Only 39 (25.8%) of the participants had average awareness about CKD and its risk factors. The overall unadjusted prevalence of CKD among diabetic patients was 78.2% (n= 119, 95% CI). The researcher found that existing history of hypertension, lack of physical exercises, family history of kidney disease, rural residency and low levels of education were independent determinants associated ......

Usability Testing of the Kidney Score Platform to Enhance Communication About Kidney Disease in Primary Care Settings: Qualitative Think-Aloud Study.

BackgroundPatient awareness of chronic kidney disease (CKD) is low in part due to suboptimal testing for CKD among those at risk and lack of discussions about kidney disease between patients and clinicians. To bridge these gaps, the National Kidney Foundation developed the Kidney Score Platform, which is a web-based series of tools that includes resources for health care professionals as well as an interactive, dynamic patient-facing component that includes a brief questionnaire about risk factors for kidney disease, individualized assessment of risk for developing CKD, and self-management tools to manage one’s kidney disease.ObjectiveThe aim of this study is to perform usability testing of the patient component of the Kidney Score platform among veterans with and at risk for kidney disease and among clinicians working as primary care providers in Veterans Affairs administration.MethodsThink-aloud exercises were conducted, during which participants (veterans and clinicians) engaged with the platform while verbalizing their thoughts and making their perceptions, reasonings, and decision points explicit. A usability facilitator observed participants’ behaviors and probed selectively to clarify their comprehension of the tool’s instructions, content, and overall functionality. Thematic analysis on the audio-recording transcripts was performed, focusing on positive attributes, negative comments, and areas that required facilitator involvement.ResultsVeterans (N=18) were 78% (14/18) male with a mean age of 58.1 years. Two-thirds (12/18) were of non-White race/ethnicity, 28% (5/18) had laboratory evidence of CKD without a formal diagnosis, and 50% (9/18) carried a diagnosis of hypertension or diabetes. Clinicians (N=19) were 29% (5/17) male, 30% (5/17) of non-White race/ethnicity, and had a mean of 17 (range 4-32) years of experience. Veterans and clinicians easily navigated the online tool and appreciated the personalized results page as well as the inclusion of infographics to deliver key educational messages. Three major themes related to content and communication about risk for CKD emerged from the think-aloud exercises: (1) tension between lay and medical terminology when discussing kidney disease and diagnostic tests, (2) importance of linking general information to concrete self-management actions, and (3) usefulness of the tool as an adjunct to the office visit to prepare for patient-clinician communication. Importantly, these themes were consistent among interviews involving both veterans and clinicians.ConclusionsVeterans and clinicians both thought that the Kidney Score Platform would successfully promote communication and discussion about kidney disease in primary care settings. Tension between using medical terminology that is used regularly by clinicians versus lay terminology to promote CKD awareness was a key challenge, and knowledge of this can inform the development of future CKD educational materials.

Development and validation of an end stage kidney disease awareness survey: Item difficulty and discrimination indices.

Lack of awareness for chronic kidney disease (CKD), including end stage kidney disease (ESKD) and their management options is a major impediment to patients being able to select and use home dialysis therapies. While some instruments have been developed to measure CKD awareness, we lack validated instruments to evaluate patients' awareness of ESKD and dialysis modalities. This study is part of multipart project for developing and validating an ESKD-centric disease awareness questionnaire. A team of specialty renal care experts developed a 45-items questionnaire encompassing the subdomains of General Kidney Knowledge, CKD Knowledge, and ESKD Knowledge. Item reduction analysis-specifically, calculation of item difficulty and item discrimination index scores-was used to items for further review and potential removal. Index scores were reviewed in conjunction with consideration of theoretical and substantive item content to reduce the number of items in the questionnaire, resulting in a 32-item questionnaire, retaining 5/10 items in the general kidney knowledge subdomain, 14/21 items in the CKD knowledge subdomain, and 13/14 items in the ESKD knowledge subdomain. Retained items ranged from 0.19 to 0.79 on the difficulty index, and from 0.31 to 0.81 on the discrimination index. Scores for percent correct on the reduced questionnaire spanned 0% to 87.5% correct on the full scale, 0% to 100% correct on the General Knowledge subdomain, 0% to 100% on the CKD Knowledge subdomain, and 0% to 92.3% on ESKD Knowledge subdomain. The questionnaire developed and refined in this study constitutes a patient disease awareness instrument that spans a range of difficulty, and yet shows strong ability to distinguish between patients with varying levels of disease awareness. This study is the first in part of a multistep project to addresses a gap in measuring ESKD specific knowledge. Accurate assessment of patients' disease awareness through a validated instrument can allow identification of knowledge domains leading to positive impacts on their healthcare decisions and improve targeted patient education efforts.