CKD Awareness in the General Population: Performance of CKD-Specific Questions

Rationale & Objective: Data from patients in one delivery system have suggested that the prevalence of chronic kidney disease (CKD) awareness differs by how the question is asked. We examined the sensitivity and specificity of different CKD awareness questions among diverse community-dwelling adults who were not necessarily engaged in primary care to determine the generalizability of prior results.

Study Design: Cross-sectional study.

Setting & Participants: Participants in the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) Study.

Predictor: CKD awareness, ascertained using 5 different questions.

Outcome: Sensitivity and specificity of each awareness question, using laboratory results as the gold standard.

Analytic Approach: Logistic regression was used to compare sensitivities of different awareness questions.

Results: Among 2,046 participants, mean (SD) age was 56.5 (9.1) years, 41.5% were men, and 61.3% were African American. More than 40% were poor, 35% reported not having health insurance, and 16.9% had low health literacy. More than 20% (n = 424) had CKD. Sensitivities of single CKD awareness questions ranged from 2.2% for "kidney damage" to 5.2% for "kidney problem." Sensitivity of the compound question asking about "weak kidneys, failing kidneys, or kidney disease" was 19.5%. Sensitivity of this compound CKD awareness question was higher among study participants with more advanced CKD and low health literacy, and those who lived below the poverty level.

Limitations: Single measures of estimated glomerular filtration rate and albuminuria; study participants may have been more engaged in their health care than the average US adult, potentially limiting the generalizability of results.

Conclusions: CKD awareness is low among community-dwelling adults with kidney disease, though data using a sensitive compound question ascertaining awareness suggest that we have met the Healthy People 2020 goal related to CKD awareness of 13.4%. Understanding the phrases about kidney disease that are most understandable to patients with and at risk for CKD is important to further increase CKD awareness.