Hospitalized Patients Lack Knowledge About Their Advanced Chronic Kidney Disease

Background:

Pre‐renal replacement therapy (RRT) patient education leads to reduced central venous catheter use, increased uptake of peritoneal dialysis, and improved access to transplant for patients with end‐stage renal disease. Yet many patients with advanced chronic kidney disease (CKD) do not receive this important education due to lack of identification or understanding of their kidney disease. The hospital is an important, often overlooked, site for patient education and linkage to nephrology care for patients with advanced CKD. Many patients with advanced CKD are hospitalized in the three months prior to dialysis initiation, which represents an opportunity to identify existing CKD and to use a multidisciplinary approach to preventative care, patient education, patient‐provider planning for future RRT needs. We sought to determine how often patients with ICD‐9 identified CKD correctly identified themselves as having kidney disease.

Methods:

Using data from the University of Chicago Hospitalist Project, a large‐scale, multi‐center study of inpatient physicians and patient outcomes, we examined data on 1,234 general medicine patients discharged between January 1, 2012 and March 31, 2012 with an ICD‐9 code for chronic kidney disease, end‐stage renal disease or transplant (585.0‐585.9, 996.81) in their first 10 admission diagnoses. We linked this data with Hospital Project patient surveys in which patients selected their chronic medical conditions from a list and were specifically asked if they had “kidney problems.” Finally, we used logistic regression to determine what clinical and demographic characteristics are associated with patients with physician‐identified CKD correctly self‐identifying as having kidney disease.

Results:

In our sample of urban adult hospitalized general medicine patients, the mean age of 60.8 with 54% females. Over 86% of patients identified as African American and 4.2% reported Hispanic ethnicity. Of the 94 patients with Stage 3 (moderate CKD, eGFR 30‐59), only 24% of patients reported having kidney problems. Of the 79 patients with advanced CKD, 61% of patients with Stage 4 (eGFR 15‐29) and 67% of patients with Stage 5 (eGFR<15) reported having kidney problems. The largest proportion of patients with CKD were coded as having CKD unspecified stage (392/1234). Of those, only 29% reported having kidney problems. Factors significantly associated with the patients correctly self‐identifying as having kidney problems include increasing CKD stage (OR 1.05, 95% CI 1.01, 1.09), race other than African American (OR 1.38, 95% CI 1.06, 1.80), all p<0.05. Every 1 year increase in age was associated with an decreased likelihood of patients with CKD correctly self‐identifying (OR 0.98, 95% CI 0.98, 0.99). In multivariable analysis, non‐African American race and younger age remained significantly associated with accurately reporting kidney problems.

Conclusions:

In this urban, hospitalized sample, patient awareness of chronic kidney disease was low, even among patients with advanced chronic kidney disease (Stage 4 and 5). The hospital provides an important, underutilized opportunity to identify, educate and refer patients with advanced chronic kidney disease in order to increase their knowledge of their renal replacement options and, ultimately, to improve patient outcomes.