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Perceived Susceptibility to Chronic Kidney Disease among High-risk Patients Seen in Primary Care Practices

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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.

DESIGN AND PARTICIPANTS

Cross-sectional study of 195 patients enrolled in a randomized controlled trial on hypertension management in 40 Maryland primary care practices.

MEASUREMENTS

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.

MAIN 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.

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Support

Grant #1K23DK070757 from the National Institute of Diabetes and Digestive and Kidney Diseases and Contract #200609197 from Amgen (Dr. Boulware); Grant #K240502643 from National Institute of Diabetes and Digestive and Kidney Diseases (Dr. Powe) and Foundation for Informed Medical Decision Making (Dr. Powe); Grants# R01HL69403 and K24HL083113 from the National Heart Lung and Blood Institute and Contract #200609197 from Amgen (Dr. Cooper)

Acknowledgements

Dr. Boulware participated in the conceptualization, funding, performance, and analysis of the study; Mrs. Carson participated in the performance and analysis of the study; Ms. Troll participated in the analysis of the study; Dr. Powe participated in the conceptualization, funding, and analysis of the study; Dr. Cooper participated in the conceptualization, funding, performance, and analysis of the study.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, USA

    L. Ebony Boulware MD, MPH, Misty U. Troll MPH, Neil R. Powe MD, MPH, MBA & Lisa A. Cooper MD, MPH

  2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    L. Ebony Boulware MD, MPH, Kathryn A. Carson ScM, Neil R. Powe MD, MPH, MBA & Lisa A. Cooper MD, MPH

  3. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

    Neil R. Powe MD, MPH, MBA & Lisa A. Cooper MD, MPH

  4. Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, USA

    L. Ebony Boulware MD, MPH, Misty U. Troll MPH, Neil R. Powe MD, MPH, MBA & Lisa A. Cooper MD, MPH

Authors
  1. L. Ebony Boulware MD, MPH
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  2. Kathryn A. Carson ScM
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  3. Misty U. Troll MPH
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  4. Neil R. Powe MD, MPH, MBA
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Corresponding author

Correspondence to L. Ebony Boulware MD, MPH.

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Boulware, L.E., Carson, K.A., Troll, M.U. et al. Perceived Susceptibility to Chronic Kidney Disease among High-risk Patients Seen in Primary Care Practices. J GEN INTERN MED 24, 1123–1129 (2009). https://doi.org/10.1007/s11606-009-1086-6

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  • DOI: https://doi.org/10.1007/s11606-009-1086-6

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