Awareness and Discussions About Chronic Kidney Disease Among African-Americans with Chronic Kidney Disease and Hypertension: a Mixed Methods Study

  • Karly A. Murphy
  • Raquel C. GreerEmail author
  • Debra L. Roter
  • Deidra C. Crews
  • Patti L. Ephraim
  • Kathryn A. Carson
  • Lisa A. Cooper
  • Michael C. Albert
  • L. Ebony Boulware
Original Research



Routine primary care visits provide an educational opportunity for African-Americans with chronic kidney disease (CKD) and CKD risk factors such as hypertension. The nature of patient-physician discussions about CKD and their impact on CKD awareness in this population have not been well explored.


To characterize patient CKD awareness and discussions about CKD between patients and primary care physicians (PCPs).


Mixed methods study.


African-American patients with uncontrolled hypertension (≥ 140/90 mmHg) and CKD (albuminuria or eGFR < 60 ml/min/1.73 m2) recruited from an urban primary care clinic.

Main Measures

We assessed patient CKD awareness with questionnaires and audio-recorded patients-PCP discussions during a routine visit. We characterized discussions and used multivariate regression analysis to identify independent patient and visit predictors of CKD awareness or CKD discussions.


Among 48 African-American patients with uncontrolled hypertension and CKD, 29% were aware of their CKD. After adjustment, CKD awareness was associated with moderate-severe CKD (stages 3–4) (vs. mild CKD [stages 1–2]) (prevalence ratio [PR] 2.82; 95% CI 1.18–6.78) and inversely associated with diabetes (vs. without diabetes) (PR 0.28; 95% CI 0.10–0.75). CKD discussions occurred in 30 (63%) visits; most focused on laboratory assessment (n = 23, 77%) or risk factor management to delay CKD progression (n = 19, 63%). CKD discussions were associated with moderate-severe CKD (vs. mild CKD) (PR 1.57; 95% CI 1.04–2.36) and diabetes (vs. without diabetes) (PR 1.42; 95% CI 1.09–1.85), and inversely associated with uncontrolled hypertension (vs. controlled) (PR 0.58; 95% CI 0.92–0.89). In subgroup analysis, follow-up CKD awareness did not change by presence or absence of CKD discussion (10.5% vs. 7.7%, p = 0.8).


In patients at risk of CKD progression, few were aware of CKD, and CKD discussions were not associated with CKD awareness. More resources may be needed to enhance the clarity of clinical messages regarding CKD and its significance for patients’ health.

Trial Registration Identifier: NCT01902719


chronic kidney disease primary care chronic disease awareness hypertension 


Funding Information

This study was funded by grants from the National Institutes of Health: 1P50HL105187 (Boulware, Carson, Cooper, Ephraim, Roter), K23DK094975 (Greer), and 2T32HL007180-41A (Murphy).

Compliance with Ethical Standards

Participants provided verbal consent to have all questionnaire, physical examination, and audio-recorded data collected. Participants’ PCPs also provided consent. Companions provided written consent to be audio-recorded if present at participants’ clinic visits. This study was approved by the Johns Hopkins and Duke University institutional review boards and registered with (NCT01902719).

Conflict of Interest

The authors declare that they do not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Karly A. Murphy
    • 1
    • 2
  • Raquel C. Greer
    • 1
    • 2
    • 3
    Email author
  • Debra L. Roter
    • 1
    • 3
    • 4
  • Deidra C. Crews
    • 2
    • 3
    • 5
  • Patti L. Ephraim
    • 2
    • 3
    • 6
  • Kathryn A. Carson
    • 1
    • 2
    • 3
    • 4
    • 6
  • Lisa A. Cooper
    • 1
    • 2
    • 3
    • 4
    • 6
  • Michael C. Albert
    • 1
    • 7
  • L. Ebony Boulware
    • 8
  1. 1.Division of General Internal Medicine, Department of MedicineJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins Medical InstitutionsBaltimoreUSA
  3. 3.Johns Hopkins Center for Health Equity, Johns Hopkins Medical InstitutionsBaltimoreUSA
  4. 4.Department of Health, Behavior, and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  5. 5.Division of Nephrology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreUSA
  6. 6.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  7. 7.Johns Hopkins Community PhysiciansJohns Hopkins UniversityBaltimoreUSA
  8. 8.Division of General Internal MedicineDuke UniversityDurhamUSA

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