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Iroegbu C, Lewis L, Matura LA. An integrative review: Chronic kidney disease awareness and the social determinants of health inequities. J Adv Nurs 2021; 78:918-928. [PMID: 34910316 DOI: 10.1111/jan.15107] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/26/2021] [Accepted: 11/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic kidney disease is a common and prevalent condition in the United States. However, 90% of individuals with chronic kidney disease are unaware of their diagnosis. AIMS To summarize the empirical and theoretical literature to provide a comprehensive understanding of the social determinants of health inequities associated with CKD awareness. Social determinants of health inequities are underlying pathways that shape the health opportunities of individuals based on their social position. DESIGN Integrative review. DATA SOURCES (May 2020 through July 2020) Data sources included PubMed, sociological abstracts, ScienceDirect, CINAHL and Google Scholar. REVIEW METHODS Quantitative, qualitative and theoretical articles describing the association of social determinants of health inequities and chronic kidney disease awareness were included. RESULTS A total of 19 articles were reviewed: two qualitative, one theoretical and 16 quantitative. CONCLUSION Findings from this review revealed that socioeconomic status, education, race and gender are consistently associated with patient chronic kidney disease awareness. These findings should serve as a basis for further research on interventions to improve chronic kidney disease awareness as well as guide nurses and health care professionals in caring for this population.
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Affiliation(s)
- Christin Iroegbu
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa Lewis
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lea Ann Matura
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Fiseha T, Ahmed E, Chalie S, Gebreweld A. Prevalence and associated factors of impaired renal function and albuminuria among adult patients admitted to a hospital in Northeast Ethiopia. PLoS One 2021; 16:e0246509. [PMID: 33539455 PMCID: PMC7861367 DOI: 10.1371/journal.pone.0246509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 01/20/2021] [Indexed: 11/22/2022] Open
Abstract
Background Chronic kidney disease (CKD) is increasingly common in hospitalized patients and is associated with increased risk for in-hospital morbidity and mortality. However, data regarding the prevalence of CKD in the African hospitalized patient population are limited. We therefore examined the prevalence and associated factors of impaired renal function and albuminuria among adult patients admitted to the internal medicine wards of a hospital in Northeast Ethiopia. Methods A cross-sectional study was conducted from January 1 to April 30, 2020 at the inpatient settings of Dessie referral hospital. Data on demographics and medical history were obtained, and serum creatinine and albuminuria were analyzed. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation. CKD was defined as impaired eGFR (<60 ml/min/1.73m2) and/or albuminuria. Univariate and multivariable analysis were conducted to determine factors associated with impaired eGFR and albuminuria. Results A total of 369 patients were included in this study. The prevalence of impaired eGFR was 19.0% (95%CI: 15.2%–23.2%) and albuminuria was 30.9% (95%CI: 26.3%–35.7%). Overall, 33.9% (95%CI: 29.2%–38.9%) of the patients had some degree of CKD, but only 21.6% (95%CI: 15.1%–29.4%) were aware of their renal disease. In multivariable analysis, older age, a family history of kidney disease, diabetes, hypertension and HIV were independently associated with both impaired eGFR and albuminuria while male gender was independently associated with only albuminuria. Conclusions CKD is common in adult patients admitted to the internal medicine wards, but only few patients are aware of their condition. These findings highlight the need for feasible approaches to timely identify kidney disease and raise awareness on the importance of detection and early intervention in the inpatient settings.
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Affiliation(s)
- Temesgen Fiseha
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- * E-mail:
| | - Ermiyas Ahmed
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Semagn Chalie
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Angesom Gebreweld
- Department of Medical Laboratory Science, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Tummalapalli SL, Vittinghoff E, Crews DC, Cushman M, Gutiérrez OM, Judd SE, Kramer HJ, Peralta CA, Tuot DS, Shlipak MG, Estrella MM. Chronic Kidney Disease Awareness and Longitudinal Health Outcomes: Results from the REasons for Geographic And Racial Differences in Stroke Study. Am J Nephrol 2020; 51:463-472. [PMID: 32349001 PMCID: PMC7448609 DOI: 10.1159/000507774] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/06/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The majority of people with chronic kidney disease (CKD) are unaware of their kidney disease. Assessing the clinical significance of increasing CKD awareness has critical public health and healthcare delivery implications. Whether CKD awareness among persons with CKD is associated with longitudinal health behaviors, disease management, and health outcomes is unknown. METHODS We analyzed data from participants with CKD in the REasons for Geographic And Racial Differences in Stroke study, a national, longitudinal, population-based cohort. Our predictor was participant CKD awareness. Outcomes were (1) health behaviors (smoking avoidance, exercise, and nonsteroidal anti-inflammatory drug use); (2) CKD management indicators (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, statin use, systolic blood pressure, fasting blood glucose, and body mass index); (3) change in estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR); and (4) health outcomes (incident end-stage kidney disease [ESKD], coronary heart disease [CHD], stroke, and death). Logistic and linear regressions were used to examine the association of baseline CKD awareness with outcomes of interest, adjusted for CKD stage and participant demographic and clinical factors. RESULTS Of 6,529 participants with baseline CKD, 285 (4.4%) were aware of their CKD. Among the 3,586 participants who survived until follow-up (median 9.5 years), baseline awareness was not associated with subsequent odds of health behaviors, CKD management indicators, or changes in eGFR and UACR in adjusted analyses. Baseline CKD awareness was associated with increased risk of ESKD (adjusted hazard ratio [aHR] 1.44; 95% CI 1.08-1.92) and death (aHR 1.18; 95% CI 1.00-1.39), but not with subsequent CHD or stroke, in adjusted models. CONCLUSIONS Individuals aware of their CKD were more likely to experience ESKD and death, suggesting that CKD awareness reflects disease severity. Most persons with CKD, including those that are high-risk, remain unaware of their CKD. There was no evidence of associations between baseline CKD awareness and longitudinal health behaviors, CKD management indicators, or eGFR decline and albuminuria.
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Affiliation(s)
- Sri Lekha Tummalapalli
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA,
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California, USA,
- San Francisco Veterans Affairs Health Care System San Francisco, San Francisco, California, USA,
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Deidra C Crews
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mary Cushman
- Departments of Medicine and Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Orlando M Gutiérrez
- Department of Epidemiology, Birmingham, Alabama, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Holly J Kramer
- Department of Public Health Sciences and Medicine, Chicago, Illinois, USA
- Division of Nephrology and Hypertension, Loyola University, Chicago, Illinois, USA
| | - Carmen A Peralta
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California, USA
- San Francisco Veterans Affairs Health Care System San Francisco, San Francisco, California, USA
- Cricket Health, Inc., San Francisco, California, USA
| | - Delphine S Tuot
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA
- Center for Innovation in Access and Quality at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California, San Francisco, California, USA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California, USA
- San Francisco Veterans Affairs Health Care System San Francisco, San Francisco, California, USA
- Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Michelle M Estrella
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California, USA
- San Francisco Veterans Affairs Health Care System San Francisco, San Francisco, California, USA
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