Awareness and Discussions About Chronic Kidney Disease Among African-Americans with Chronic Kidney Disease and Hypertension: a Mixed Methods Study

Karly A Murphy; Raquel C Greer; Debra L Roter; Deidra C Crews; Patti L Ephraim; Kathryn A Carson; Lisa A Cooper; Michael C Albert; L Ebony Boulware

doi:10.1007/s11606-019-05540-3

Awareness and Discussions About Chronic Kidney Disease Among African-Americans with Chronic Kidney Disease and Hypertension: a Mixed Methods Study

J Gen Intern Med. 2020 Jan;35(1):298-306. doi: 10.1007/s11606-019-05540-3. Epub 2019 Nov 12.

Authors

Karly A Murphy^{1

2}, Raquel C Greer^{3

4

5}, Debra L Roter^{1

6

7}, Deidra C Crews^{2

6

8}, Patti L Ephraim^{2

6

9}, Kathryn A Carson^{1

2

6

7

9}, Lisa A Cooper^{1

2

6

7

9}, Michael C Albert^{1

10}, L Ebony Boulware¹¹

Affiliations

¹ Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
³ Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. rgreer@jhmi.edu.
⁴ Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA. rgreer@jhmi.edu.
⁵ Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, MD, USA. rgreer@jhmi.edu.
⁶ Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
⁷ Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁸ Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁹ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹⁰ Johns Hopkins Community Physicians, Johns Hopkins University, Baltimore, MD, USA.
¹¹ Division of General Internal Medicine, Duke University, Durham, NC, USA.

Abstract

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) (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 CKD, and CKD discussions were not associated with CKD awareness. More resources may be needed to enhance the clarity of clinical messages regarding CKD and its significance for patients' health.

Trial registration: ClinicalTrials.gov Identifier: NCT01902719.

Keywords: awareness; chronic disease; chronic kidney disease; hypertension; primary care.

Publication types

Clinical Study
Research Support, N.I.H., Extramural

MeSH terms

Black or African American
Diabetes Mellitus*
Glomerular Filtration Rate
Humans
Hypertension* / diagnosis
Hypertension* / epidemiology
Renal Insufficiency, Chronic* / diagnosis
Renal Insufficiency, Chronic* / epidemiology
Risk Factors

Associated data

ClinicalTrials.gov/NCT01902719

Abstract

Publication types

MeSH terms

Associated data

Grants and funding