title: Perceived susceptibility to chronic kidney disease among high-risk patients seen in primary care practices.
abstract: BACKGROUND
  Patients' views of their risk for the development or progression of chronic kidney disease (CKD) are poorly characterized.
  
  
  OBJECTIVE
  To assess perceived risk and concern regarding CKD development or progression among high-risk patients seen in primary care, identify predictors of perceptions, and correlate perceptions with adherence to high blood pressure management.
  
  
  METHODS
  Cross-sectional study of 195 patients enrolled in a randomized controlled trial on hypertension management in 40 Maryland primary care practices.
  
  
  METHODS
  We assessed independent predictors (sociodemographics, health literacy, clinical presence of CKD, co-morbid conditions, and health behaviors) of perceived susceptibility (assessed via questionnaire) and adherence (assessed via Hill-Bone blood pressure adherence scale) in multivariable analyses.
  
  
  RESULTS
  In this hypertensive majority African American (63%) population, many participants had uncontrolled blood pressure (44%) or diabetes (42%). Few (20%) felt "very likely" to develop CKD and one third (33%) were "very concerned" about developing CKD. Participants who were female and had low health literacy had lower perceived susceptibility to CKD compared to males and those with higher health literacy. Race and diabetes were also associated with perceived susceptibility. Greater perceived susceptibility was associated with poorer blood pressure management adherence scores.
  
  
  CONCLUSIONS
  Many high-risk patients have low perceived susceptibility to CKD. Poor blood pressure therapy adherence scores among those with greatest perceived susceptibility suggest fatalistic attitudes about CKD. If our findings are confirmed in larger studies, interventions targeting patient perceptions of CKD risk and other attitudes associated with these perceptions could impact adherence to therapies and health outcomes.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Welch Center for Prevention, Epidemiology and Clinical Research, 2024 E. Monument Street, Baltimore, MD 21205, USA. lboulwa@jhmi.edu
authors.forename: L Ebony
authors.initials: LE
authors.lastname: Boulware
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Carson
authors.forename: Misty U
authors.initials: MU
authors.lastname: Troll
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Cooper
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004198:Disease Susceptibility; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012307:Risk Factors; D012649:Self Concept