Factors Associated with CKD Awareness and Impact on Kidney Prognosis

Background: Behavioral change and awareness of healthy living are important elements for caring for patients with chronic kidney disease (CKD). Despite the importance of CKD awareness, few patients, even those diagnosed with CKD, are aware of their disease. We aimed to investigate the factors associated with CKD awareness and its impact on renal prognosis. In this study, we focused on urine tests and nutritional guidance, which are typical clinical quality indicators in CKD practice Methods: The study examined the proportion of participants with CKD who underwent health checkups from 2013 to 2022 and responded that they were aware of CKD in the questionnaire. The outcome was the change from CKD “unaware” to “aware”, and multivariable logistic regression analysis was used to examine the association of urine testing or nutritional guidance with CKD awareness. A control group was randomly selected from the unaware group and matched for age, sex, and estimated glomerular filtration rate (eGFR). The change in eGFR slopes before and after the occurrence of awareness was compared using mixed-effects models. Results: Of the 13,489 participants, 372 (2.8%) were aware of having CKD at baseline, and of the 1,614 participants who had CKD-related diseases in their claims data, only 316 (19.6%) were aware of their CKD status. The odds ratios of urine test or nutritional guidance associated with the occurrence of awareness were 1.72 (95% confidence interval [CI] 1.13–2.62) and 2.91 (95% CI 1.41–6.01), respectively. Compared to the pre-occurrence of awareness, the post-occurrence eGFR slope improved by 0.94 mL/min/1.73 m2 per year (95% CI 0.17–1.72, P=0.017) (Figure). Conclusion: Our findings suggest that urine tests and nutritional guidance may promote CKD awareness, which may help slow its progression.