Perceived Susceptibility to Chronic Kidney Disease among High-risk Patients Seen in Primary Care Practices

• Published in: Journal of general internal medicine : JGIM 2009-10, Vol.24 (10), p.1123-1129
• Main Authors: Boulware, L. Ebony, Carson, Kathryn A., Troll, Misty U., Powe, Neil R., Cooper, Lisa A.
• Format: Article
• Language: English
• Subjects: Adult; Attitudes; Biological and medical sciences; Chronic illnesses; Cross-Sectional Studies; Disease Susceptibility; Female; Follow-Up Studies; General aspects; Health behavior; Health Knowledge, Attitudes, Practice; Humans; Internal Medicine; Kidney diseases; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - etiology; Kidney Failure, Chronic - psychology; Kidneys; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Original; Original Article; Primary care; Primary Health Care; Renal failure; Risk Factors; Self Concept; Urinary system involvement in other diseases. Miscellaneous
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-009-1086-6

BACKGROUND Patients’ views of their risk for the development or progression of chronic kidney disease (CKD) are poorly characterized. OBJECTIVE 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. MEASUREMENTS 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. MAIN RESULTS 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. CONCLUSIONS 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.