Perceived Susceptibility to Chronic Kidney Disease among High-risk Patients Seen in Primary Care Practices
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Patients’ views of their risk for the development or progression of chronic kidney disease (CKD) are poorly characterized.
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.
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.
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.
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 WORDSchronic kidney disease attitudes perceived susceptibility adherence primary care
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)
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
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