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
Research background

Chronic kidney disease (CKD) awareness is low in the primary care patient population with greater awareness in the advanced stages of CKD. Awareness of CKD is the first step for patient adherence to the numerous CKD-specific health behaviors necessary for optimal management of CKD. In order for patients to perform these behaviors appropriately, it is necessary that they be knowledgeable and health literate about these behaviors. Previous studies on CKD awareness have been based on larger databases and have focused on clinical markers and only few health behaviors. Additionally, previous work has not studied whether CKD awareness is associated with health literacy, or with actual performance of self-management behaviors, particularly in a specialty nephrology clinical practice setting.

Research motivation

While it may be assumed that being aware of having CKD will motivate patients to improve their health outcomes particularly in a specialty nephrology clinic setting, it has never been previously studied within this setting. Additionally, CKD awareness and kidney function relationships have not been previously examined, nor has actual performance of CKD specific behaviors been previously examined. This study examines the relationships between CKD awareness, health literacy, kidney function, CKD self-management behavior knowledge and its performance in a specialty practice setting. Examining these relationships will offer useful information to clinicians regarding how to design the best interventions for different stages of CKD, taking into account factors such as CKD awareness, health literacy, and self-management behavior performance.

Research objectives

The purpose of this study was to examine the relationship between CKD-A and: (1) Knowledge of current CKD self-management behaviors (CKD-SMB); (2) performance of CKD-SMB in previous three months as a measure of engagement in behavior c) HL, and d) kidney function (eGFR) in patients attending a specialty nephrology clinic. Learning more about these relationships will allow clinicians to use more targeted interventions with their patients.

Research methods

The authors used surveys to measure health literacy, self-management behavior knowledge, and performance, and CKD awareness. At the same time, the authors extracted information from medical records to determine CKD cause, serum creatinine levels, and length of time attending specialty clinic. Serum creatinine levels were converted to estimate glomerular filtration rates (EGFR) values using the MDRD-4 equation. The uniqueness of our study is that the authors used actual prospective data collection rather than retrospective data which most current studies in the literature have used.

Research results

This study examined CKD-A in patients with CKD stages 1-4 in a nephrology specialty clinic and as expected, found that awareness of having CKD was high among patients in this outpatient nephrology specialty clinic. However, the authors found that 10/25 (40%) of patients in stages 1 and 2, and 8/125 (6.4%) in stages 3 and 4 were unaware of their CKD. The authors did not find any relationships between CKD-A and HL, and with most CKD-SMBs. No relationship between CKD-A and knowledge of CKD-SMBs and performance of the same in the previous three months was found either. However, similar to other studies, the authors found CKD-A was significantly higher with worse renal function, and this relationship remained significant even after controlling for demographics and length of time attending clinic. Future efforts should include longitudinal studies that focus primarily on CKD-specific behaviors and beginning in the early stages of CKD. Also, since the authors saw that awareness was associated with kidney function, future work should determine the effect of awareness on renal function trajectory.

Research conclusions

Some new findings from our study include: (1) although awareness of CKD was high, it did not translate into better CKD self-management behavior knowledge or actual performance of behaviors even in worse stages of CKD; (2) the authors also found that awareness was significantly associated with kidney function but not with health literacy; (3) The authors found that large percent of patients reported being knowledgeable about CKD self-management behaviors, but there was no relationship between knowledge and performance of those behaviors. Based on this study, the authors theorize that among the several factors that affect kidney function, CKD awareness is a significant factor. However, the pathway by which awareness affects kidney function is unknown. It is possible that awareness arises only after kidney function decline, implying that raising awareness in the earlier stages of the disease may minimize the rate of kidney function decline. As health literacy and self-management behaviors are not associated with awareness, it suggests that just being aware of having CKD does not guarantee that individuals will perform self-management behaviors, or become health literate. The mechanisms to improve kidney function through awareness pathway need to be further assessed by longitudinal studies. CKD-A is not associated with HL, nor does it translate into better CKD-SMBs. CKD-A is significantly associated with kidney function, with awareness occurring with substantially lower eGFR. While the current literature indicates that CKD awareness is low, our study found a high level of CKD awareness. One reason for a high level of awareness may be that it was conducted in a specialty practice setting. Also, current literature does not address awareness and self-management behaviors or kidney function, both which our study addresses. The new hypothesis that this study proposes include: a) CKD awareness arises after kidney function decline. This study proposes examination of the relationship between CKD awareness and kidney function using longitudinal studies. Clinical practitioners should enhance and focus patient education of CKD in the earlier stages of CKD when awareness may be low. Also, practitioners should differentiate between CKD-specific behaviors and general health behaviors, so that patients clearly understand the CKD-specific behaviors needed to prevent kidney function decline.

Research perspectives

A larger sample size would help confirm the study results. Also, conducting this study in multiple practice settings will help improve generalizability. Future research should be longitudinal in nature and examine the relationship between CKD awareness and renal function trajectory. Future research should be longitudinal with a larger sample size and multiple specialty clinics.