Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Jan 6, 2018; 7(1): 41-50
Published online Jan 6, 2018. doi: 10.5527/wjn.v7.i1.41
Awareness, self-management behaviors, health literacy and kidney function relationships in specialty practice
Radhika Devraj, Matthew E Borrego, A Mary Vilay, Junvie Pailden, Bruce Horowitz
Radhika Devraj, School of Pharmacy, Southern Illinois University Edwardsville, Edwardsville, IL 62026, United States
Matthew E Borrego, A Mary Vilay, College of Pharmacy, University of New Mexico, Albuquerque, NM 87131, United States
Junvie Pailden, College of Arts and Sciences, Southern Illinois University Edwardsville, Edwardsville, IL 62026, United States
Bruce Horowitz, Division of Nephrology and Hypertension, University of Utah, Salt Lake City, UT 84112, United States
Author contributions: Borrego WE, Vilay AM and Horowitz B were involved in study design, assisted with data collection, interpretation of data, revising the manuscript, providing intellectual content of critical importance, and approval of final version; Pailden J (statistician) was contributed to help with data analysis and interpretation, revising the manuscript, providing intellectual content of critical importance and approval of final version; Devraj R was responsible for idea concept, study design, development of data collection tools, data entry and cleaning, interpretation of data, providing intellectual content of critical importance, wrote and revised the manuscript.
Supported by SIUE STEP.
Institutional review board statement: This study was reviewed and approved by the Southern Illinois University Edwardsville Institutional Review Board and University of New Mexico Institutional Review Board.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: None of the authors have any conflicts of interest.
Data sharing statement: Dataset available from the corresponding author at rdevraj@siue.edu. Consent was not obtained for data sharing, but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Radhika Devraj, PhD, Associate Professor, School of Pharmacy, Southern Illinois University Edwardsville, 200 University Park Drive, Suite 250, Edwardsville, IL 62026, Unites States. rdevraj@siue.edu
Telephone: +1-618-6505137 Fax: +1-618-6505152
Received: August 17, 2017
Peer-review started: August 18, 2017
First decision: October 9, 2017
Revised: November 20, 2017
Accepted: December 1, 2017
Article in press: December 1, 2017
Published online: January 6, 2018

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.

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

Core tip: Chronic kidney disease (CKD) awareness has not been examined in a specialty clinic environment. This study examined the associations between CKD awareness, health literacy, CKD self-management behaviors, past performance of self-management behaviors, and kidney function. We found that majority of the participants in our study were aware of having CKD. CKD awareness increased as CKD worsened; however, nearly 40% of patients in CKD stages 1 and 2 and about 6% of patients in CKD stages 3 and 4 were unaware of having CKD. CKD awareness was not related to health literacy, self-management behavior knowledge, or past performance of behaviors.