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Predictors of patient self-report of chronic kidney disease: baseline analysis of a randomised controlled trial.

Gaffney H, Blakeman T, Blickem C, Kennedy A, Reeves D, Dawson S, Mossabir R, Bower P, Gardner C, Lee V, Rogers A - BMC Fam Pract (2014)

Bottom Line: Self-report rates did not appreciably differ by practice.Multivariate analysis revealed that female patients (p = 0.004), and patients with stage 3b CKD (p < 0.001), and with higher anxiety levels (p < 0.001), were more likely to self-report CKD.Self-report of kidney problems by patients on CKD registers was variable and patterned by sociodemographic factors.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Improving the quality of care for patients with vascular disease is a priority. Clinical guidance has emphasised the importance of early identification and active management of chronic kidney disease (CKD) in primary care in order to maintain vascular health. However, awareness of stage 3 CKD amongst patients remains limited. We aimed to identify predictors of patient self-report of CKD to inform tailoring of conversations around CKD in primary care for diverse patient populations.

Methods: We conducted a cross-sectional analysis of baseline data from 436 patients with stage 3 CKD from 24 GP practices taking part in a randomised controlled trial (RCT) evaluating a complex self-management intervention, which aimed to support the maintenance of vascular health in patients with stage 3 CKD. Potential predictors of patient self-report of CKD included demographics, stage of CKD, cardiovascular risk, self-reported co-morbidities, health status, self-management ability, and health service utilisation.

Results: Around half (52%, n = 227) of patients did not self-report CKD. Self-report rates did not appreciably differ by practice. Multivariate analysis revealed that female patients (p = 0.004), and patients with stage 3b CKD (p < 0.001), and with higher anxiety levels (p < 0.001), were more likely to self-report CKD.

Conclusions: Self-report of kidney problems by patients on CKD registers was variable and patterned by sociodemographic factors. Although it cannot be assumed that failure to self-report indicates a lack of awareness of CKD, our data do suggest the need for greater consistency in discussions around kidney health, with meaningful and relevant clinical dialogue that is aligned with existing clinical encounters to enable shared decision making and minimise anxiety.

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Related in: MedlinePlus

Bar graph indicating the percentage1of patients reporting kidney problems by gender.1Percentages controlled for other significant predictors (CKD stage and HADS-anxiety).
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Fig1: Bar graph indicating the percentage1of patients reporting kidney problems by gender.1Percentages controlled for other significant predictors (CKD stage and HADS-anxiety).

Mentions: Variance inflation factors amongst the explanatory variables entered into the multivariate analysis were all low (maximum =2.3), indicating acceptable multicollinearity [29]. Since both stage of CKD and proteinuria were potential explanatory variables, we also added their interaction term to the initial model. In multivariate analysis, just three variables remained in the model as independent predictors of self-report of CKD: stage of CKD, gender and anxiety. Women were more likely to self-report CKD than men (OR = 1.68, 95% CI 1.18-2.39). The relationship with anxiety was nonlinear: patients with low levels of anxiety (HADS <=3) and moderate anxiety scores (HADS =4 to 7) had very similar degrees of awareness, but patients with clinical levels of anxiety (HADS >=8) were much more likely to show awareness (OR = 2.83, 95% CI 1.44-5.54) compared to low anxiety. The association with stage of CKD indicated considerably higher levels of self-report amongst patients at stage 3b compared to stage 3a (OR = 2.94, 95% CI 2.16-4.01) (see Table 2). Subgroup differences are illustrated in Figures 1, 2 and 3. The model as a whole explained approximately 13% of the variance in patient awareness (McKelvey and Zavoina’s R2 = .13).Table 2


Predictors of patient self-report of chronic kidney disease: baseline analysis of a randomised controlled trial.

Gaffney H, Blakeman T, Blickem C, Kennedy A, Reeves D, Dawson S, Mossabir R, Bower P, Gardner C, Lee V, Rogers A - BMC Fam Pract (2014)

Bar graph indicating the percentage1of patients reporting kidney problems by gender.1Percentages controlled for other significant predictors (CKD stage and HADS-anxiety).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4260196&req=5

Fig1: Bar graph indicating the percentage1of patients reporting kidney problems by gender.1Percentages controlled for other significant predictors (CKD stage and HADS-anxiety).
Mentions: Variance inflation factors amongst the explanatory variables entered into the multivariate analysis were all low (maximum =2.3), indicating acceptable multicollinearity [29]. Since both stage of CKD and proteinuria were potential explanatory variables, we also added their interaction term to the initial model. In multivariate analysis, just three variables remained in the model as independent predictors of self-report of CKD: stage of CKD, gender and anxiety. Women were more likely to self-report CKD than men (OR = 1.68, 95% CI 1.18-2.39). The relationship with anxiety was nonlinear: patients with low levels of anxiety (HADS <=3) and moderate anxiety scores (HADS =4 to 7) had very similar degrees of awareness, but patients with clinical levels of anxiety (HADS >=8) were much more likely to show awareness (OR = 2.83, 95% CI 1.44-5.54) compared to low anxiety. The association with stage of CKD indicated considerably higher levels of self-report amongst patients at stage 3b compared to stage 3a (OR = 2.94, 95% CI 2.16-4.01) (see Table 2). Subgroup differences are illustrated in Figures 1, 2 and 3. The model as a whole explained approximately 13% of the variance in patient awareness (McKelvey and Zavoina’s R2 = .13).Table 2

Bottom Line: Self-report rates did not appreciably differ by practice.Multivariate analysis revealed that female patients (p = 0.004), and patients with stage 3b CKD (p < 0.001), and with higher anxiety levels (p < 0.001), were more likely to self-report CKD.Self-report of kidney problems by patients on CKD registers was variable and patterned by sociodemographic factors.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Improving the quality of care for patients with vascular disease is a priority. Clinical guidance has emphasised the importance of early identification and active management of chronic kidney disease (CKD) in primary care in order to maintain vascular health. However, awareness of stage 3 CKD amongst patients remains limited. We aimed to identify predictors of patient self-report of CKD to inform tailoring of conversations around CKD in primary care for diverse patient populations.

Methods: We conducted a cross-sectional analysis of baseline data from 436 patients with stage 3 CKD from 24 GP practices taking part in a randomised controlled trial (RCT) evaluating a complex self-management intervention, which aimed to support the maintenance of vascular health in patients with stage 3 CKD. Potential predictors of patient self-report of CKD included demographics, stage of CKD, cardiovascular risk, self-reported co-morbidities, health status, self-management ability, and health service utilisation.

Results: Around half (52%, n = 227) of patients did not self-report CKD. Self-report rates did not appreciably differ by practice. Multivariate analysis revealed that female patients (p = 0.004), and patients with stage 3b CKD (p < 0.001), and with higher anxiety levels (p < 0.001), were more likely to self-report CKD.

Conclusions: Self-report of kidney problems by patients on CKD registers was variable and patterned by sociodemographic factors. Although it cannot be assumed that failure to self-report indicates a lack of awareness of CKD, our data do suggest the need for greater consistency in discussions around kidney health, with meaningful and relevant clinical dialogue that is aligned with existing clinical encounters to enable shared decision making and minimise anxiety.

Show MeSH
Related in: MedlinePlus