Awareness and Discussions About Chronic Kidney Disease Among African-Americans with Chronic Kidney Disease and Hypertens
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Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; 3Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, MD, USA; 4Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 5Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 6Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 7Johns Hopkins Community Physicians, Johns Hopkins University, Baltimore, MD, USA; 8Division of General Internal Medicine, Duke University, Durham, NC, USA.
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) Karly A. Murphy and Raquel C. Greer are joint first authors. Prior Presentations The findings of this study were previously presented as a poster at Society of General Internal Medicine Annual Meeting in 2018 in Denver, CO. Received March 29, 2019 Revised September 9, 2019 Accepted October 9, 2019
(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
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