title: Associations between access to care and awareness of CKD.
abstract: BACKGROUND
  Most individuals with chronic kidney disease (CKD) in the United States are unaware of their condition, creating challenges in implementing early interventions to delay disease progression. Whether characteristics expected to enhance health care access are associated with greater CKD awareness has not been studied adequately.
  
  
  METHODS
  Data from volunteer participants in the National Kidney Foundation's Kidney Early Evaluation Program (KEEP), 2000-2010, with presumed CKD (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m(2) or albumin-creatinine ratio >30 mg/g) were analyzed. Given that the diagnosis of CKD was based on a single measurement of kidney function, the diagnosis is presumed, but not confirmed. Associations of CKD awareness with measures of access to care (health insurance coverage, type of health insurance, prescription drug coverage, and self-reported level of difficulty obtaining care) were examined using logistic regression.
  
  
  RESULTS
  Of 29,144 participants with CKD, 6,751 (23%) reported CKD awareness. No significant association was found between availability of health insurance or prescription drug coverage and CKD awareness; results did not vary by diabetic status or in analyses restricted to participants with eGFR <60 mL/min/1.73 m(2). Participants reporting extreme or some difficulty obtaining medical care were more likely than those reporting no difficulty to be aware of CKD (adjusted OR, 1.25; 95% CI, 1.05-1.50).
  
  
  CONCLUSIONS
  Most KEEP participants with CKD are unaware of the condition, results that are not modified by the availability of health insurance or prescription drug coverage. The mechanisms underlying the association of perceived difficulty in access to care with greater CKD awareness require further study.
authors.affiliation: Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA 90502, USA.
authors.forename: Anuja
authors.initials: A
authors.lastname: Shah
authors.forename: Linda F
authors.initials: LF
authors.lastname: Fried
authors.forename: Shu-Cheng
authors.initials: SC
authors.lastname: Chen
authors.forename: Yang
authors.initials: Y
authors.lastname: Qiu
authors.forename: Suying
authors.initials: S
authors.lastname: Li
authors.forename: Kerri L
authors.initials: KL
authors.lastname: Cavanaugh
authors.forename: Keith C
authors.initials: KC
authors.lastname: Norris
authors.forename: Adam T
authors.initials: AT
authors.lastname: Whaley-Connell
authors.forename: Peter A
authors.initials: PA
authors.lastname: McCullough
authors.forename: Rajnish
authors.initials: R
authors.lastname: Mehrotra
mesh_terms: D002908:Chronic Disease; D059026:Diagnostic Self Evaluation; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged