Published in:
01-01-2020 | Care | Original Research
Awareness and Discussions About Chronic Kidney Disease Among African-Americans with Chronic Kidney Disease and Hypertension: a Mixed Methods Study
Published in: Journal of General Internal Medicine | Issue 1/2020
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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