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State-Level Awareness of Chronic Kidney Disease in the U.S.

  • Sai H. Dharmarajan
    Affiliations
    Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan

    Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, Michigan

    Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
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  • Jennifer L. Bragg-Gresham
    Affiliations
    Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan

    Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, Michigan
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  • Hal Morgenstern
    Affiliations
    Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan

    Department of Urology, Medical School, University of Michigan, Ann Arbor, Michigan

    Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
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  • Brenda W. Gillespie
    Affiliations
    Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, Michigan

    Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
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  • Yi Li
    Affiliations
    Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, Michigan

    Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
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  • Neil R. Powe
    Affiliations
    Department of Medicine, University of California San Francisco, San Francisco, California
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  • Delphine S. Tuot
    Affiliations
    Department of Medicine, University of California San Francisco, San Francisco, California
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  • Tanushree Banerjee
    Affiliations
    Department of Medicine, University of California San Francisco, San Francisco, California
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  • Nilka Ríos Burrows
    Affiliations
    Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • Deborah B. Rolka
    Affiliations
    Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • Sharon H. Saydah
    Affiliations
    Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • Rajiv Saran
    Correspondence
    Address correspondence to: Rajiv Saran, MD, Division of Nephrology, Department of Internal Medicine, School of Medicine, Department of Epidemiology, School of Public Health, University of Michigan, University of Michigan-Kidney Epidemiology and Cost Center, 1415 Washington Heights, SPH I, Suite 3645, Ann Arbor MI 48109-2029
    Affiliations
    Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan

    Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, Michigan

    Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
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  • on behalf of the Centers for Disease Control and Prevention CKD Surveillance System

      Introduction

      This study examined state-level variation in chronic kidney disease (CKD) awareness using national estimates of disease awareness among adults in the U.S. with CKD.

      Methods

      Data on U.S. adults were obtained from two national, population-based surveys: (1) the Behavioral Risk Factor Surveillance System (BRFSS 2011; n=506,467), a state-level phone survey containing information on self-reported kidney disease; and (2) the National Health and Nutrition Examination Survey (NHANES 2005–2012; n=20,831), containing physical health examination, surveys containing data on self-reported kidney disease, risk factors, and laboratory values. CKD was defined as an estimated glomerular filtration rate of 15–59 mL/minute/1.73 m2 or urinary albumin-to-creatinine ratio >30 mg/g. As BRFSS does not include laboratory data, CKD status for each person was imputed (multiple) based on a logistic regression model predicting NHANES CKD status. CKD awareness in each state was estimated as the weighted proportion of BRFSS participants with imputed CKD who reported having kidney disease.

      Results

      Overall, estimated CKD awareness was 9.0% (95% CI=8.0%, 10.0%), ranging from 5.8% (95% CI=4.8%, 6.8%) in Iowa to 11.7% (95% CI=9.7%, 13.7%) in Arizona. Awareness was greater among adults with hypertension (12.0%) and diabetes (15.3%) than among adults without those conditions, and lower in Hispanics (6.0%) than in non-Hispanic whites (8.8%), non-Hispanic blacks (9.9%), and other racial/ethnic groups (12.7%).

      Conclusions

      Among individuals with CKD, awareness of their condition was very low and varied approximately twofold among states. This is the first study to estimate awareness of kidney disease by state for the U.S. adult population.
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