• epidemiology and outcomes
• kidney disease
• social determinants of health

• Advance care planning
• Chronic kidney disease
• Palliative care
• Patient-centered care

• Humans
• Ghana
• Male
• Advance Care Planning
• Hospitals, Teaching
• Female
• Renal Insufficiency, Chronic/therapy
• Renal Insufficiency, Chronic/psychology
• Middle Aged
• Adult
• Aged
• Quality of Life

• Acceptance
• Hemodialysis
• Logo-therapy
• Self-awareness

• CKD
• CKD awareness
• awareness
• chronic kidney disease
• nursing
• renal nursing
• social determinants of health

• ICD-10 code
• chronic kidney disease
• diagnostic status
• doctors’ perception
• electronic health record

• National Natural Science Foundation of China

• CKD awareness
• Chronic kidney disease
• knowledge
• meta-analysis
• review

• F32 DK122629 NIDDK NIH HHS

Chronic kidney disease (CKD) is common but often goes unrecorded.

Cross-sectional.

Military Health System (MHS) beneficiaries aged 18 to 64 years who received care during fiscal years 2016 to 2018.

Age, sex, active duty status, race, diabetes, hypertension, and numbers of kidney test results.

We defined CKD by International Classification of Diseases, Tenth Revision (ICD-10) code and/or a positive result on a validated electronic phenotype that uses estimated glomerular filtration rate and measures of proteinuria with evidence of chronicity. We defined coded CKD by the presence of an ICD-10 code. We defined uncoded CKD by a positive e-phenotype result without an ICD-10 code.

We compared coded and uncoded populations using 2-tailed t tests (continuous variables) and Pearson χ² test for independence (categorical variables).

The MHS population included 3,330,893 beneficiaries. Prevalence of CKD was 3.2%, based on ICD code and/or positive e-phenotype result. Of those identified with CKD, 63% were uncoded. Compared with beneficiaries with coded CKD, those with uncoded CKD were younger (aged 45 ± 13 vs 52 ± 11 years), more often women (54.4% vs 37.6%) and active duty (20.2% vs 12.5%), and less often of Black race (18.5% vs 31.5%) or with diabetes (23.5% vs 43.5%) or hypertension (46.6% vs 77.1%; P < 0.001). Beneficiaries with coded (vs uncoded) CKD had greater numbers of kidney test results (P < 0.001).

Use of cross-sectional administrative data prevents inferences about causality. The CKD e-phenotype may fail to capture CKD in individuals without laboratory data and may underestimate CKD.

The prevalence of CKD in the MHS is ~3.2%. Beneficiaries with well-known CKD risk factors, such as older age, male sex, Black race, diabetes, and hypertension, were more likely to be coded, suggesting that clinicians may be missing CKD in groups traditionally considered lower risk, potentially resulting in suboptimal care.

• Chronic kidney disease
• chronic renal disease
• chronic renal insufficiency
• electronic health record
• electronic phenotype
• estimated glomerular filtration rate
• medical record
• proteinuria

• Animals
• Epithelial Cells/drug effects
• Humans
• Kidney/cytology
• Kidney/drug effects
• Male
• Mice
• Mice, Inbred C57BL
• Microplastics/toxicity
• Polystyrenes/toxicity

A brief comprehensive overview is provided of the elements constituting the burden of kidney disease [chronic kidney disease (CKD) and acute kidney injury]. This publication can be used for advocacy, emphasizing the importance and urgency of reducing this heavy and rapidly growing burden. Kidney diseases contribute to significant physical limitations, loss of quality of life, emotional and cognitive disorders, social isolation and premature death. CKD affects close to 100 million Europeans, with 300 million being at risk, and is projected to become the fifth cause of worldwide death by 2040. Kidney disease also imposes financial burdens, given the costs of accessing healthcare and inability to work. The extrapolated annual cost of all CKD is at least as high as that for cancer or diabetes. In addition, dialysis treatment of kidney diseases imposes environmental burdens by necessitating high energy and water consumption and producing plastic waste. Acute kidney injury is associated with further increases in global morbidity, mortality and economic burden. Yet investment in research for treatment of kidney disease lags behind that of other diseases. This publication is a call for European investment in research for kidney health. The innovations generated should mirror the successful European Union actions against cancer over the last 30 years. It is also a plea to nephrology professionals, patients and their families, caregivers and kidney health advocacy organizations to draw, during the Decade of the Kidney (2020–30), the attention of authorities to realize changes in understanding, research and treatment of kidney disease.

• acute kidney injury
• chronic kidney disease
• dialysis
• environment
• epidemiology
• health economy
• kidney transplantation
• mortality
• non-communicable diseases
• peritoneal dialysis

Chronic kidney disease (CKD) is increasingly common in hospitalized patients and is associated with increased risk for in-hospital morbidity and mortality. However, data regarding the prevalence of CKD in the African hospitalized patient population are limited. We therefore examined the prevalence and associated factors of impaired renal function and albuminuria among adult patients admitted to the internal medicine wards of a hospital in Northeast Ethiopia.

A cross-sectional study was conducted from January 1 to April 30, 2020 at the inpatient settings of Dessie referral hospital. Data on demographics and medical history were obtained, and serum creatinine and albuminuria were analyzed. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation. CKD was defined as impaired eGFR (<60 ml/min/1.73m²) and/or albuminuria. Univariate and multivariable analysis were conducted to determine factors associated with impaired eGFR and albuminuria.

A total of 369 patients were included in this study. The prevalence of impaired eGFR was 19.0% (95%CI: 15.2%–23.2%) and albuminuria was 30.9% (95%CI: 26.3%–35.7%). Overall, 33.9% (95%CI: 29.2%–38.9%) of the patients had some degree of CKD, but only 21.6% (95%CI: 15.1%–29.4%) were aware of their renal disease. In multivariable analysis, older age, a family history of kidney disease, diabetes, hypertension and HIV were independently associated with both impaired eGFR and albuminuria while male gender was independently associated with only albuminuria.

CKD is common in adult patients admitted to the internal medicine wards, but only few patients are aware of their condition. These findings highlight the need for feasible approaches to timely identify kidney disease and raise awareness on the importance of detection and early intervention in the inpatient settings.

• Albuminuria/epidemiology
• Albuminuria/physiopathology
• Cross-Sectional Studies
• Ethiopia
• Glomerular Filtration Rate/physiology
• Hospitals/statistics & numerical data
• Humans
• Prevalence
• Renal Insufficiency, Chronic/epidemiology
• Renal Insufficiency, Chronic/physiopathology
• Risk Factors

Diabetic retinopathy (DR) may be asymptomatic in both mild and advanced stages. A patient’s accurate perception of their DR severity may therefore be critical for effective self-management behaviors and understanding the need for timely intervention and follow-up.

To evaluate the relationship between self-reported and actual retinopathy severity in diabetic patients.

This study was a single-center cross-sectional survey. Diabetic patients identified by enterprise data warehouse were sent an online questionnaire where they were asked to self-assess for presence of DR and grade their severity. Actual DR grading was determined via chart review. The primary outcome measures were patient-assessed DR severity and agreement with actual DR severity.

Of 3208 invitations sent, 324 (10%) patients responded and 319 responses were analyzed. The data showed that 39 of 253 (15%) with no DR, 26 of 40 (65%) with mild/moderate DR, and 24 of 26 (92%) with severe DR believed they had DR (p<0.001). Of those with no DR, 214 of 253 (85%) accurately assessed absence of DR. Of those with mild/moderate DR, 25 of 40 (63%) accurately assessed their severity, 14 of 40 (35%) believed they had no DR, and 1 of 40 (3%) believed they had severe DR. In patients with severe DR, 9 of 26 (35%) correctly assessed their severity, 15 of 26 (58%) believed they had mild/moderate DR, and 2 of 26 (8%) believed they had no DR.

Patients with severe DR were the most likely to report presence of DR, but often underestimated their disease severity. Many with mild/moderate DR did not realize they had DR. This consistent underestimation of severity across all a significant barrier to timely follow-up and treatment necessary to prevent future visual impairment.

• Northwestern Medicine Enterprise Data Warehouse Pilot Data Program

• Acute kidney injury
• Awareness
• Knowledge

• Acute Kidney Injury/complications
• Acute Kidney Injury/diagnosis
• Acute Kidney Injury/epidemiology
• Acute Kidney Injury/physiopathology
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Cardiovascular Diseases/etiology
• Cardiovascular Diseases/prevention & control
• Communication
• Cross-Sectional Studies
• Female
• Health Knowledge, Attitudes, Practice
• Humans
• Kidney/physiopathology
• Male
• Middle Aged
• Patient Education as Topic
• Recurrence
• Renal Insufficiency, Chronic/etiology
• Renal Insufficiency, Chronic/prevention & control
• Risk Factors
• Surveys and Questionnaires/statistics & numerical data
• Survivors/statistics & numerical data
• Young Adult

• UL1 TR000445 NCATS NIH HHS
• P30 DK079341 NIDDK NIH HHS
• T32 DK007569 NIDDK NIH HHS
• R01 DK103935 NIDDK NIH HHS
• K23 DK114566 NIDDK NIH HHS
• P30 DK114809 NIDDK NIH HHS

• kidney disease chronic
• kidney transplantation
• qualitative research
• hermeneutic
• nursing
• care

• Adult
• Aged
• Female
• Hermeneutics
• Humans
• Kidney Transplantation/psychology
• Male
• Middle Aged
• Qualitative Research
• Renal Insufficiency, Chronic/psychology
• Renal Insufficiency, Chronic/surgery
• Social Behavior
• Young Adult

• Acute illness
• Chronic
• Hospital readmission
• Humans
• Medication Adherence
• Medication Therapy Management
• Medication management
• Renal Insufficiency
• Transitional care
• chronic kidney disease
• hospitalization

• Aged
• Aged, 80 and over
• Ambulatory Care
• Emergency Service, Hospital
• Female
• Glomerular Filtration Rate
• House Calls
• Humans
• Kidney/physiopathology
• Male
• Medication Therapy Management/organization & administration
• Middle Aged
• Patient Admission
• Patient Discharge
• Patient Readmission
• Pharmaceutical Services/organization & administration
• Pharmacists/organization & administration
• Professional Role
• Renal Insufficiency, Chronic/diagnosis
• Renal Insufficiency, Chronic/physiopathology
• Renal Insufficiency, Chronic/therapy
• Severity of Illness Index
• Single-Blind Method
• Time Factors
• Treatment Outcome
• Washington

• R34 DK094016 NIDDK NIH HHS

To determine the relationship between chronic kidney disease (CKD) awareness (CKD-A), self-management behaviors (CKD-SMB) knowledge, performance of CKD-SMBs, health literacy (HL) and kidney function.

Participants were eligible patients attending an outpatient nephrology clinic. Participants were administered: Newest Vital Sign to measure HL, CKD self-management knowledge tool (CKD-SMKT) to assess knowledge, past performance of CKD-SMB, CKD-A. Estimated GFR (eGFR) was determined using the MDRD-4 equation. Duration of clinic participation and CKD cause were extracted from medical charts.

One-hundred-fifty patients participated in the study. eGFRs ranged from 17-152 mL/min per 1.73 m². Majority (83%) of respondents had stage 3 or 4 CKD, low HL (63%), and were CKD aware (88%). Approximately 40% (10/25) of patients in stages 1 and 2 and 6.4% (8/125) in stages 3 and 4 were unaware of their CKD. CKD-A differed with stage (P < 0.001) but not by HL level, duration of clinic participation, or CKD cause. Majority of respondents (≥ 90%) correctly answered one or more CKD-SMKT items. Knowledge of one behavior, “controlling blood pressure” differed significantly by CKD-A. CKD-A was associated with past performance of two CKD-SMBs, “controlling blood pressure” (P = 0.02), and “keeping healthy body weight” (P = 0.01). Adjusted multivariate analyses between CKD-A and: (1) HL; and (2) CKD-SMB knowledge were non-significant. However, there was a significant relationship between CKD-A and kidney function after controlling for demographics, HL, and CKD-SMB (P < 0.05).

CKD-A is not associated with HL, or better CKD-SMBs. CKD-A is significantly associated with kidney function and substantially lower eGFR, suggesting the need for focused patient education in CKD stages 1.

• Chronic kidney disease awareness
• Health literacy
• Kidney function
• Self-management behaviors
• Self-management behavior performance
• Epidermal growth factor receptor
• Chronic kidney disease knowledge

Patient awareness of their chronic kidney disease (CKD) and health literacy (HL) are both important for adherence to therapies that slow CKD progression and to reduce risk of complications. Little is known about the association between HL and CKD awareness.

We sought to determine if patient HL is associated with CKD awareness.

We conducted a cross-sectional study of general medicine inpatients at an urban academic medical center discharged between June 2011 and July 2013 with CKD, defined as having at least one CKD International Classification of Diseases, ninth revision code (585.0–585.9), among their first 20 admission diagnoses. Logistic regression was used to analyze the influence of HL, demographic, clinical, and health care use covariates on the likelihood of patients' CKD awareness. Our primary outcome was patient awareness of their CKD, defined as correct patient self-report of “kidney problems.” We used the Brief Health Literacy Screen, a three-item verbal questionnaire, to assess HL.

Among 1,308 patients with CKD, awareness of CKD was 33%, and 48% had adequate HL. However, CKD awareness was not associated with HL even among patients with stage 4 or 5 CKD. In multivariable logistic regression, greater awareness was associated with being a woman, younger than age 50 years, married, White, having hypertension, and having a higher CKD stage (all p < .05). In stratified analyses, patients with hypertension had greater CKD awareness, regardless of HL or diabetes status (p < .05).

Among hospitalized patients with CKD, both CKD awareness and HL are low and inadequate. Surprisingly, patients' knowledge of their CKD diagnosis was not related to patients' HL. Patients with hypertension who young, white, or married may be receiving or retaining more education related to CKD. More work is needed on how to effectively communicate CKD diagnosis to prevent widening health disparities. [Health Literacy Research and Practice. 2017;1(3):e117–e127.]

We studied whether patients with low health literacy also had low awareness of their chronic kidney disease (CKD). Hospitalized patients with CKD were asked three questions about their health literacy and whether they had “kidney problems.” Overall CKD awareness and health literacy were low, but a low score on one did not predict a low score on the other.

• K23 DK103111 NIDDK NIH HHS

• Chronic kidney disease
• Patient education
• Patient preferences
• Patient-centred care
• Self-management

• Chronic kidney disease
• Environment
• Haemodialysis
• Psychosocial
• Quality improvement
• Self-management/Self-care