title: Is awareness of chronic kidney disease associated with evidence-based guideline-concordant outcomes?
abstract: BACKGROUND
  Awareness of chronic kidney disease (CKD) is low. Efforts are underway to increase recognition of CKD among patients, assuming that such an increase will lead to better outcomes through greater adherence to proven therapies. Few studies have tested this assumption.
  
  
  METHODS
  CKD awareness, defined by a 'yes' answer to 'Have you ever been told by a healthcare provider you have weak or failing kidneys?', was assessed among 2,404 adults with CKD stages 1-4, who participated in the 2003-2008 National Health and Nutrition Examination Surveys. Odds of blood pressure (BP) control, self-reported use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB), and glycemic control, were determined among those aware vs. unaware of their CKD.
  
  
  RESULTS
  Optimal BP control, ACEI/ARB use and glycemic control were low in the US adult population with CKD, although there was a recent increase in attainment of guideline-concordant BP control. Odds of BP control and ACEI/ARB use were not different among individuals aware of their CKD compared to those unaware (adjusted odds ratio (AOR) 0.91; 95% CI 0.52-1.58 and AOR 0.75; 0.44-1.30, respectively). CKD awareness among diabetic participants was not associated with glycemic control (AOR 0.41; 95% CI 0.14-1.18).
  
  
  CONCLUSIONS
  Awareness of CKD is not associated with more optimal BP control, ACEI/ARB use or glycemic control. Future efforts in this area should further explore the measurement of CKD awareness and behaviors associated with CKD awareness.
authors.affiliation: Division of Nephrology, University of California, San Francisco, 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: Neil R
authors.initials: NR
authors.lastname: Powe
mesh_terms: D000328:Adult; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001364:Awareness; D001794:Blood Pressure; D016001:Confidence Intervals; D003920:Diabetes Mellitus / Q000378:metabolism; D019317:Evidence-Based Medicine; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys / Q000706:statistics & numerical data*; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology / Q000523:psychology*; D055815:Young Adult
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D006442:Glycated Hemoglobin