Prevalence, awareness, and management of CKD and cardiovascular risk factors in publicly funded health care

Clin J Am Soc Nephrol. 2014 Apr;9(4):713-9. doi: 10.2215/CJN.06550613. Epub 2014 Jan 23.


Background and objectives: It is uncertain how many patients with CKD and cardiovascular risk factors in publicly funded universal health care systems are aware of their disease and how to achieve their treatment targets.

Design, setting, participants, & measurements: The CARTaGENE study evaluated BP, lipid, and diabetes profiles as well as corresponding treatments in 20,004 random individuals between 40 and 69 years of age. Participants had free access to health care and were recruited from four regions within the province of Quebec, Canada in 2009 and 2010.

Results: CKD (Chronic Kidney Disease Epidemiology Collaboration equation; <60 ml/min per 1.73 m(2)) was present in 4.0% of the respondents, and hypertension, diabetes, and hypercholesterolemia were reported by 25%, 7.4%, and 28% of participants, respectively. Self-awareness was low: 8% for CKD, 73% for diabetes, and 45% for hypercholesterolemia. Overall, 31% of patients with hypertension did not meet BP goals, and many received fewer antihypertensive drugs than appropriately controlled individuals; 41% of patients with diabetes failed to meet treatment targets. Among those patients with a moderate or high Framingham risk score, 53% of patients had LDL levels above the recommended levels, and many patients were not receiving a statin. Physician checkups were not associated with greater awareness but did increase the achievement of targets.

Conclusion: In this population with access to publicly funded health care, CKD and cardiovascular risk factors are common, and self-awareness of these conditions is low. Recommended targets were frequently not achieved, and treatments were less intensive in those patients who failed to reach goals. New strategies to enhance public awareness and reach guideline targets should be developed.

MeSH terms

  • Adult
  • Aged
  • Awareness*
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / prevention & control*
  • Cross-Sectional Studies
  • Diabetes Mellitus / diagnosis
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / therapy
  • Female
  • Health Behavior
  • Health Care Surveys
  • Health Knowledge, Attitudes, Practice*
  • Health Promotion
  • Health Services Accessibility
  • Humans
  • Hypercholesterolemia / diagnosis
  • Hypercholesterolemia / epidemiology
  • Hypercholesterolemia / therapy
  • Hypertension / diagnosis
  • Hypertension / epidemiology
  • Hypertension / therapy
  • Male
  • Middle Aged
  • Patient Education as Topic
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'
  • Prevalence
  • Preventive Health Services* / economics
  • Public Sector* / economics
  • Quebec / epidemiology
  • Renal Insufficiency, Chronic / diagnosis
  • Renal Insufficiency, Chronic / epidemiology
  • Renal Insufficiency, Chronic / therapy*
  • Risk Assessment
  • Risk Factors
  • State Medicine* / economics
  • Treatment Outcome