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

  • L. Ebony Boulware
  • Kathryn A. Carson
  • Misty U. Troll
  • Neil R. Powe
  • Lisa A. Cooper
Original Article

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.

KEY WORDS

chronic kidney disease attitudes perceived susceptibility adherence primary care 

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Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • L. Ebony Boulware
    • 1
    • 2
    • 4
  • Kathryn A. Carson
    • 2
  • Misty U. Troll
    • 1
    • 4
  • Neil R. Powe
    • 1
    • 2
    • 3
    • 4
  • Lisa A. Cooper
    • 1
    • 2
    • 3
    • 4
  1. 1.Division of General Internal Medicine, Department of MedicineJohns Hopkins School of MedicineBaltimoreUSA
  2. 2.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins Medical InstitutionsBaltimoreUSA

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