Tuot Delphine S, Zhu Yunnuo, Velasquez Alexandra, Espinoza Juan, Mendez C Damaris, Banerjee Tanushree, Hsu Chi-Yuan, Powe Neil R
Division of Nephrology.
Center for Vulnerable Populations, and.
Clin J Am Soc Nephrol. 2016 Sep 7;11(9):1566-1573. doi: 10.2215/CJN.00490116. Epub 2016 Jun 23.
Awareness of CKD is necessary for patient engagement and adherence to medical regimens. Having an accurate tool to assess awareness is important. Use of the National Health and Nutrition Examination Survey (NHANES) CKD awareness question "Have you ever been told by a doctor or other health professional that you had weak or failing kidneys (excluding kidney stones, bladder infections, or incontinence)?" produces surprisingly low measures of CKD awareness. We sought to compare the sensitivity and specificity of different questions ascertaining awareness of CKD and other health conditions.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Between August of 2011 and August of 2014, an in-person questionnaire was administered to 220 adults with CKD, diabetes, hypertension, or hyperlipidemia who received primary care in a public health care delivery system to ascertain awareness of each condition. CKD awareness was measured using the NHANES question, and other questions, asking if patients knew about their "kidney disease", "protein in the urine", "kidney problem", or "kidney damage." Demographic data were self-reported; health literacy was measured. The sensitivity and specificity of each question was calculated using the medical record as the gold standard.
In this diverse population (9.6% white, 40.6% black, 36.5% Hispanic, 12.3% Asian), the mean age was 58 years, 30% had a non-English language preference, and 45% had low health literacy. Eighty percent of participants had CKD, with a mean eGFR of 47.2 ml/min per 1.73 m(2). The sensitivities of each CKD awareness question were: 26.4% for "kidney damage", 27.7% for "kidney disease", 33.2% for "weak or failing kidneys", 39.8% for "protein in the urine", and 40.1% for "kidney problem." Specificities ranged from 82.2% to 97.6%. The best two-question combination yielded a sensitivity of 53.1% and a specificity of 83.3%. This was lower than awareness of hypertension (90.1%) or diabetes (91.8%).
CKD awareness is low compared with other chronic diseases regardless of how it is ascertained. Nevertheless, more sensitive questions to ascertain CKD awareness suggest current under-ascertainment.
了解慢性肾脏病（CKD）对于患者参与和坚持医疗方案至关重要。拥有准确的评估知晓情况的工具很重要。使用美国国家健康与营养检查调查（NHANES）中关于CKD知晓情况的问题“你是否曾被医生或其他健康专业人员告知你有肾脏虚弱或功能衰退（不包括肾结石、膀胱感染或尿失禁）？”得出的CKD知晓率出奇地低。我们试图比较不同问题在确定CKD及其他健康状况知晓情况方面的敏感性和特异性。
设计、地点、参与者与测量：在2011年8月至2014年8月期间，对220名患有CKD、糖尿病、高血压或高脂血症且在公共医疗保健系统接受初级护理的成年人进行了面对面问卷调查，以确定他们对每种疾病的知晓情况。使用NHANES问题以及其他问题来测量CKD知晓情况，这些问题询问患者是否知道自己的“肾脏疾病”“尿蛋白”“肾脏问题”或“肾脏损伤”。人口统计学数据由患者自行报告；对健康素养进行了测量。以病历作为金标准计算每个问题的敏感性和特异性。
在这个多样化的人群中（9.6%为白人，40.6%为黑人，36.5%为西班牙裔，12.3%为亚裔），平均年龄为58岁，30%的人偏好非英语，45%的人健康素养较低。80%的参与者患有CKD，估算肾小球滤过率（eGFR）平均为47.2 ml/（min·1.73 m²）。每个CKD知晓情况问题的敏感性分别为：“肾脏损伤”为26.4%，“肾脏疾病”为27.7%，“肾脏虚弱或功能衰退”为33.2%，“尿蛋白”为39.8%，“肾脏问题”为40.1%。特异性范围为82.2%至97.6%。最佳的两个问题组合的敏感性为53.1%，特异性为83.3%。这低于高血压（90.1%）或糖尿病（91.8%）的知晓率。
无论如何确定，与其他慢性病相比，CKD的知晓率较低。然而，用于确定CKD知晓情况的更敏感问题表明目前存在知晓情况未被充分确定的问题。
