title: Chronic kidney disease awareness among individuals with clinical markers of kidney dysfunction.
abstract: OBJECTIVE
  Awareness of chronic kidney disease (CKD) among providers and patients is low. Whether clinical cues prompt recognition of CKD is unknown. We examined whether markers of kidney disease that should trigger CKD recognition among providers are associated with higher individual CKD awareness.
  
  
  METHODS
  CKD awareness was assessed in 1852 adults with an estimated GFR <60 ml/min per 1.73 m(2) using 1999 to 2008 National Health and Nutrition Examination Survey data. CKD awareness was a "yes" answer to "Have you ever been told you have weak or failing kidneys?" Participants were grouped by distribution of the following abnormal markers of CKD: hyperkalemia, acidosis, hyperphosphatemia, elevated blood urea nitrogen, anemia, albuminuria, and uncontrolled hypertension. Odds of CKD awareness associated with each abnormal marker and groupings of markers were estimated by multivariable logistic regression.
  
  
  RESULTS
  Among individuals with kidney disease, only those with albuminuria had greater odds of CKD awareness (adjusted odds ratio, 4.0, P < 0.01) than those without. Odds of CKD awareness increased with each additional manifested clinical marker of CKD (adjusted odds ratio, 1.3, P = 0.05). Nonetheless, 90% of individuals with two to four markers of CKD and 84% of individuals with ≥5 markers of CKD were unaware of their disease.
  
  
  CONCLUSIONS
  Although individuals who manifest many markers of kidney dysfunction are more likely to be aware of their CKD, their CKD awareness remains low. A better understanding of mechanisms of awareness is required to facilitate earlier detection of CKD and implement therapy to minimize associated complications.
authors.affiliation: 521 Parnassus Avenue, Clinical Science Building C-443, Box 0532, Division of Nephrology, University of California, San Francisco, San Francisco, CA 94143, USA. Delphine.tuot@ucsf.edu
authors.forename: Delphine S
authors.initials: DS
authors.lastname: Tuot
authors.forename: Laura C
authors.initials: LC
authors.lastname: Plantinga
authors.forename: Chi-Yuan
authors.initials: CY
authors.lastname: Hsu
authors.forename: Regina
authors.initials: R
authors.lastname: Jordan
authors.forename: Nilka Ríos
authors.initials: NR
authors.lastname: Burrows
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hedgeman
authors.forename: Jerry
authors.initials: J
authors.lastname: Yee
authors.forename: Rajiv
authors.initials: R
authors.lastname: Saran
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
mesh_terms: D000328:Adult; D000368:Aged; D001364:Awareness; D015415:Biomarkers / Q000097:blood / Q000652:urine; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology / Q000652:urine; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010353:Patient Education as Topic; D011237:Predictive Value of Tests; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult
chemical_list: D015415:Biomarkers