Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA 90502, USA.
Am J Kidney Dis. 2012 Mar;59(3 Suppl 2):S16-23. doi: 10.1053/j.ajkd.2011.10.042.
Most individuals with chronic kidney disease (CKD) in the United States are unaware of their condition, creating challenges in implementing early interventions to delay disease progression. Whether characteristics expected to enhance health care access are associated with greater CKD awareness has not been studied adequately.
Data from volunteer participants in the National Kidney Foundation's Kidney Early Evaluation Program (KEEP), 2000-2010, with presumed CKD (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m(2) or albumin-creatinine ratio >30 mg/g) were analyzed. Given that the diagnosis of CKD was based on a single measurement of kidney function, the diagnosis is presumed, but not confirmed. Associations of CKD awareness with measures of access to care (health insurance coverage, type of health insurance, prescription drug coverage, and self-reported level of difficulty obtaining care) were examined using logistic regression.
Of 29,144 participants with CKD, 6,751 (23%) reported CKD awareness. No significant association was found between availability of health insurance or prescription drug coverage and CKD awareness; results did not vary by diabetic status or in analyses restricted to participants with eGFR <60 mL/min/1.73 m(2). Participants reporting extreme or some difficulty obtaining medical care were more likely than those reporting no difficulty to be aware of CKD (adjusted OR, 1.25; 95% CI, 1.05-1.50).
Most KEEP participants with CKD are unaware of the condition, results that are not modified by the availability of health insurance or prescription drug coverage. The mechanisms underlying the association of perceived difficulty in access to care with greater CKD awareness require further study.
在美国，大多数患有慢性肾脏病 (CKD) 的人都不知道自己的病情，这给实施早期干预以延缓疾病进展带来了挑战。尚未充分研究预计会增强获得医疗保健机会的特征是否与更高的 CKD 意识相关。
对 2000-2010 年参加国家肾脏基金会肾脏早期评估计划 (KEEP) 的志愿者参与者的数据进行了分析，这些参与者被认为患有 CKD（估计肾小球滤过率[eGFR] <60 mL/min/1.73 m(2)或白蛋白-肌酐比值>30 mg/g）。由于 CKD 的诊断基于单次肾功能测量，因此该诊断是假定的，但未经证实。使用逻辑回归检查 CKD 意识与获得医疗保健的措施（医疗保险覆盖范围、医疗保险类型、处方药覆盖范围和自我报告的获得医疗保健的难度）之间的关联。
在 29144 名患有 CKD 的参与者中，有 6751 名（23%）报告了 CKD 意识。医疗保险或处方药覆盖的可用性与 CKD 意识之间没有显著关联；结果不因糖尿病状态而异，也不因在 eGFR <60 mL/min/1.73 m(2)的参与者中进行的分析而有所不同。报告医疗保健非常困难或有一定困难的参与者比报告没有困难的参与者更有可能意识到 CKD（调整后的 OR，1.25；95%CI，1.05-1.50）。
KEEP 参与者中大多数患有 CKD 的人都不知道自己的病情，这一结果不受医疗保险或处方药覆盖范围的影响。需要进一步研究导致感知获得医疗保健的困难与更高的 CKD 意识之间的关联的机制。
