Departments of Medicine, University of California San Francisco, San Francisco, CA.
Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA.
Am J Kidney Dis. 2020 Aug;76(2):174-183. doi: 10.1053/j.ajkd.2020.01.007. Epub 2020 Apr 15.
RATIONALE & OBJECTIVE: Persons with chronic kidney disease (CKD) are often unaware of their disease status. Efforts to improve CKD awareness may be most effective if focused on persons at highest risk for progression to kidney failure.
Serial cross-sectional surveys.
SETTING & PARTICIPANTS: Nonpregnant adults (aged≥20 years) with CKD glomerular filtration rate categories 3-4 (G3-G4) who participated in the National Health and Nutrition Examination Survey from 1999 to 2016 (n = 3,713).
5-year kidney failure risk, estimated using the Kidney Failure Risk Equation. Predicted risk was categorized as minimal (<2%), low (2%-<5%), intermediate (5%-<15%), or high (≥15%).
CKD awareness, defined by answering "yes" to the question "Have you ever been told by a doctor or other health professional that you had weak or failing kidneys?"
Prevalence of CKD awareness was estimated within each risk group using complex sample survey methods. Associations between Kidney Failure Risk Equation risk and CKD awareness were assessed using multivariable logistic regression. CKD awareness was compared with awareness of hypertension and diabetes during the same period.
In 2011 to 2016, unadjusted CKD awareness was 9.6%, 22.6%, 44.7%, and 49.0% in the minimal-, low-, intermediate-, and high-risk groups, respectively. In adjusted analyses, these proportions did not change over time. Awareness of CKD, including among the highest risk group, remains consistently below that of hypertension and diabetes and awareness of these conditions increased over time.
Imperfect sensitivity of the "weak or failing kidneys" question for ascertaining CKD awareness.
Among adults with CKD G3-G4 who have 5-year estimated risks for kidney failure of 5%-<15% and≥15%, approximately half were unaware of their kidney disease, a gap that has persisted nearly 2 decades.
患有慢性肾脏病（CKD）的患者通常不知道自己的疾病状况。如果将努力重点放在最有可能进展为肾衰竭的高危人群身上，提高 CKD 知晓率的效果可能最为显著。
连续的横断面研究。
参加了 1999 年至 2016 年期间的国家健康和营养检查调查（NHANES）的患有 CKD 肾小球滤过率（GFR）3-4 期（G3-G4）的非妊娠成年人（年龄≥20 岁）（n=3713）。
使用肾脏衰竭风险方程（KFRE）估计的 5 年肾衰竭风险。预测风险分为低危（<2%）、中危（2%-<5%）、高危（5%-<15%）和极高危（≥15%）。
CKD 知晓率，定义为回答“医生或其他健康专业人员是否曾告诉您，您的肾脏功能较弱或衰竭？”。
采用复杂样本调查方法，在每个风险组内估计 CKD 知晓率。使用多变量逻辑回归评估 KFRE 风险与 CKD 知晓率之间的关联。将 CKD 知晓率与同期高血压和糖尿病的知晓率进行比较。
2011 年至 2016 年，在最小风险组、低风险组、中风险组和高风险组中，未经调整的 CKD 知晓率分别为 9.6%、22.6%、44.7%和 49.0%。在调整分析中，这些比例在整个研究期间没有变化。包括最高风险组在内的 CKD 知晓率仍然明显低于高血压和糖尿病的知晓率，而且这些疾病的知晓率随着时间的推移而增加。
用于确定 CKD 知晓率的“肾脏功能较弱或衰竭”问题的敏感性不完美。
在患有 GFR 3-4 期 CKD、5 年内肾衰竭风险为 5%-<15%和≥15%的成年人中，约有一半人不知道自己患有肾脏疾病，这一差距已经持续了近 20 年。
