Patient Awareness of CKD: A Systematic Review and Meta-analysis of Patient-Oriented Questions and Study Setting

Chi D Chu; Michael H Chen; Charles E McCulloch; Neil R Powe; Michelle M Estrella; Michael G Shlipak; Delphine S Tuot

doi:10.1016/j.xkme.2021.03.014

Patient Awareness of CKD: A Systematic Review and Meta-analysis of Patient-Oriented Questions and Study Setting

Kidney Med. 2021 Jun 1;3(4):576-585.e1. doi: 10.1016/j.xkme.2021.03.014. eCollection 2021 Jul-Aug.

Authors

Chi D Chu¹, Michael H Chen², Charles E McCulloch³, Neil R Powe^{1

4

5}, Michelle M Estrella^{6

7}, Michael G Shlipak^{6

7}, Delphine S Tuot^{1

4

5}

Affiliations

¹ Department of Medicine, University of California, San Francisco.
² Minerva Schools at Keck Graduate Institute, San Francisco, CA.
³ Department of Epidemiology and Biostatistics, University of California, San Francisco.
⁴ Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, University of California, San Francisco.
⁵ Center for Vulnerable Populations, University of California, San Francisco.
⁶ Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco.
⁷ Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, CA.

Abstract

Rationale & objective: Patient awareness of disease is the first step toward effective management and disease control. Awareness of chronic kidney disease (CKD) has consistently been shown to be low, but studies estimating patient awareness of CKD have used different methods. We sought to determine whether the estimated prevalence of CKD awareness differed by the wording used to ascertain awareness or by setting characteristics.

Study design: Systematic review and meta-analysis.

Setting & study populations: Adults with CKD not receiving dialysis.

Selection criteria for studies: We included studies that estimated CKD awareness, determined CKD status by laboratory criteria, and provided the exact question wording used to ascertain awareness.

Data extraction: 2 reviewers independently extracted data for each study; discordance was resolved by a third independent reviewer.

Analytical approach: Mixed-effects models were used to calculate pooled CKD awareness estimates and 95% CIs.

Results: 32 studies were included. Publication year ranged from 2004 to 2017, with study populations ranging from 107 to 28,923 individuals. CKD awareness in individual studies ranged from 0.9% to 94.0%. Pooled CKD awareness was 19.2% (95% CI, 10.0%-33.6%) overall and was 26.5% (95% CI, 11.9%-48.9%) among individuals with an estimated glomerular filtration rate < 60 mL/min/1.73 m². "Kidney problem" was the most sensitive question for CKD awareness (58.7%; 95% CI, 32.4%-80.8%); "weak or failing kidneys" was the least sensitive (12.3%; 95% CI, 4.5%-29.4%). CKD awareness was highest among patients from nephrology practices (86.2%; 95% CI, 74.9%-93.0%) and lowest in the general population (7.3%; 95% CI, 5.0%-10.5%).

Limitations: Significant heterogeneity across studies overall and among examined subgroups of wording and study setting.

Conclusions: Differently worded questions may lead to widely different estimates of CKD awareness. Consistent terminology is likely needed to most effectively surveil and leverage CKD awareness to improve management and disease control.

Keywords: CKD awareness; Chronic kidney disease; knowledge; meta-analysis; review.

Grants and funding

F32 DK122629/DK/NIDDK NIH HHS/United States