title: Awareness of kidney disease and relationship to end-stage renal disease and mortality.
abstract: BACKGROUND
  Often, patients with chronic kidney disease are reported to be unaware of it. We prospectively evaluated the association between awareness of kidney disease to end-stage renal disease and mortality.
  
  
  METHODS
  We utilized 2000-2009 data from the National Kidney Foundation's Kidney Early Evaluation Program. Mortality was determined by cross reference to the Social Security Administration Death Master File and development of end stage by cross reference with the United States Renal Data System.
  
  
  RESULTS
  Of 109,285 participants, 28,244 (26%) had chronic kidney disease defined by albuminuria or estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2). Only 9% (n=2660) reported being aware of kidney disease. Compared with those who were not aware, participants aware of chronic kidney disease had lower eGFR (49 vs 62 mL/min/1.73 m(2)) and a higher prevalence of albuminuria (52% vs. 46%), diabetes (47% vs 42%), cardiovascular disease (43% vs 28%), and cancer (23% vs 14%). Over 8.5 years of follow-up, aware participants compared with those unaware had a lower rate of survival for end stage (83% and 96%) and mortality (78% vs 81%), P <.001. After adjustment for demographics, socioeconomic factors, comorbidity, and severity of kidney disease, aware participants continued to demonstrate an increased risk for end-stage renal disease (hazard ratio 1.37; 95% confidence interval, 1.07-1.75; P <.0123) and mortality (hazard ratio 1.27; 95% confidence interval, 1.07-1.52; P <.0077) relative to unaware participants with chronic kidney disease.
  
  
  CONCLUSIONS
  Among patients identified as having chronic kidney disease at a health screening, only a small proportion had been made aware of their diagnosis previously by clinicians. This subgroup was at a disproportionately high risk for mortality and end-stage renal disease.
authors.affiliation: Division of Nephrology and Hypertension, Harry S. Truman VA Medical Center, Columbia, Missouri, USA. whaleyconnella@health.missouri.edu
authors.forename: Adam
authors.initials: A
authors.lastname: Whaley-Connell
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Inker
authors.forename: Manjula
authors.initials: M
authors.lastname: Kurella Tamura
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Bomback
authors.forename: Georges
authors.initials: G
authors.lastname: Saab
authors.forename: Susanna M
authors.initials: SM
authors.lastname: Szpunar
authors.forename: Samy I
authors.initials: SI
authors.lastname: McFarlane
authors.forename: Suying
authors.initials: S
authors.lastname: Li
authors.forename: Shu-Cheng
authors.initials: SC
authors.lastname: Chen
authors.forename: Keith
authors.initials: K
authors.lastname: Norris
authors.forename: George L
authors.initials: GL
authors.lastname: Bakris
authors.forename: Peter A
authors.initials: PA
authors.lastname: McCullough
mesh_terms: D000368:Aged; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology