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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Awareness and Discussions About Chronic Kidney Disease Among African-Americans with Chronic Kidney Disease and
Karly A Murphy1,2, Raquel C Greer3,4,5, Debra L Roter1,6,7
1Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Insights
Few African-Americans with chronic kidney disease (CKD) were aware of their condition, and discussions with primary care physicians did not improve awareness. Enhanced communication strategies are needed to improve patient understanding of CKD.
Area of Science:
- Nephrology
- Public Health
- Health Disparities
Background:
- Routine primary care visits offer educational opportunities for African-Americans with chronic kidney disease (CKD) and hypertension.
- Patient-physician discussions about CKD and their impact on awareness in this population are under-explored.
Purpose of the Study:
- To characterize CKD awareness among African-American patients.
- To analyze discussions about CKD between patients and primary care physicians (PCPs).
Main Methods:
- A mixed-methods study involving African-American patients with uncontrolled hypertension and CKD.
- Assessment of CKD awareness via questionnaires and audio-recorded patient-PCP discussions.
- Multivariate regression analysis to identify predictors of CKD awareness and discussions.
Main Results:
- Only 29% of patients were aware of their CKD; awareness correlated with CKD severity and inversely with diabetes.
- CKD discussions occurred in 63% of visits, focusing on lab results or risk management.
- CKD discussions were linked to CKD severity and diabetes but inversely to uncontrolled hypertension.
Conclusions:
- Low CKD awareness persists in at-risk populations, and discussions do not significantly improve it.
- Enhanced clinical communication is crucial for conveying the significance of CKD to patients.
- Further resources are needed to improve patient understanding of CKD and its health implications.
Background:
Routine primary care visits provide an educational opportunity for African-Americans with chronic kidney disease (CKD) and CKD risk factors such as hypertension. The nature of patient-physician discussions about CKD and their impact on CKD awareness in this population have not been well explored.
Objective:
To characterize patient CKD awareness and discussions about CKD between patients and primary care physicians (PCPs).
Design:
Mixed methods study.
Patients:
African-American patients with uncontrolled hypertension (≥ 140/90 mmHg) and CKD (albuminuria or eGFR < 60 ml/min/1.73 m2) recruited from an urban primary care clinic.
Main Measures:
We assessed patient CKD awareness with questionnaires and audio-recorded patients-PCP discussions during a routine visit. We characterized discussions and used multivariate regression analysis to identify independent patient and visit predictors of CKD awareness or CKD discussions.
Results:
Among 48 African-American patients with uncontrolled hypertension and CKD, 29% were aware of their CKD. After adjustment, CKD awareness was associated with moderate-severe CKD (stages 3-4) (vs. mild CKD [stages 1-2]) (prevalence ratio [PR] 2.82; 95% CI 1.18-6.78) and inversely associated with diabetes (vs. without diabetes) (PR 0.28; 95% CI 0.10-0.75). CKD discussions occurred in 30 (63%) visits; most focused on laboratory assessment (n = 23, 77%) or risk factor management to delay CKD progression (n = 19, 63%). CKD discussions were associated with moderate-severe CKD (vs. mild CKD) (PR 1.57; 95% CI 1.04-2.36) and diabetes (vs. without diabetes) (PR 1.42; 95% CI 1.09-1.85), and inversely associated with uncontrolled hypertension (vs. controlled) (PR 0.58; 95% CI 0.92-0.89). In subgroup analysis, follow-up CKD awareness did not change by presence or absence of CKD discussion (10.5% vs. 7.7%, p = 0.8).
Conclusions:
In patients at risk of CKD progression, few were aware of CKD, and CKD discussions were not associated with CKD awareness. More resources may be needed to enhance the clarity of clinical messages regarding CKD and its significance for patients' health.
Trial Registration:
ClinicalTrials.gov Identifier: NCT01902719.
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