Limited Knowledge of Chronic Kidney Disease and Its Main Risk Factors among Iranian Community: An Appeal for Promoting National Public Health Education Programs

Document Type : Original Article

Authors

1 Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Medical Students Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran

4 Department of Nephrology, Isfahan University of Medical Sciences, Isfahan, Iran

5 Endocrinology and Diabetes Division, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background
The aim of this survey was to explore the baseline knowledge of the Iranian community about Chronic Kidney Disease (CKD) definition and its two main risk factors, i.e. diabetes and hypertension. This study also introduced a model of public education program with the purpose of reducing the incidence of CKD in high-risk groups and thereby decreasing the economic burden of CKD in Iran.
 
Methods
This cross-sectional study was conducted on world kidney day 2013 in Isfahan, Iran. Self-administered anonymous questionnaires evaluating the knowledge of CKD and its risk factors were distributed among subjects who participated in a kidney disease awareness campaign. Chi-square test and logistic regression analysis were used to examine the differences in the level of knowledge across different socio-demographic groups.
 
Results
The questionnaires were completed by 748 respondents. The majority of these respondents believed that “pain in the flanks” and “difficulty in urination” was the early symptoms of CKD. Roughly, 10.4% knew that CKD could be asymptomatic in the initial stages. Only 12.7% knew diabetes and 14.4% knew hypertension was a CKD risk factor. The respondents who had a CKD risk factor (i.e. diabetes and/or hypertension) were significantly more likely than respondents without CKD risk factor to select “unmanaged diabetes” [Odds Ratio (OR)= 2.2, Confidence Interval (CI) (95%): 1.4–3.6] and “unmanaged hypertension” [OR= 1.9, CI(95%): 1.2–3.0] as “very likely to result in CKD”. No more than 34.6% of all respondents with diabetes and/or hypertension reported that their physician has ever spoken with them about their increased risk for developing CKD.
 
Conclusion
The knowledge of Iranian population about CKD and its risk factors is low. Future public health education programs should put efforts in educating Iranian community about the asymptomatic nature of CKD in its initial stages and highlighting the importance of regular renal care counseling. The high-risk individuals should receive tailored education and be encouraged to adopt lifestyle modifications to prevent or slow the progression of CKD.

Keywords

Main Subjects


  1. Levey AS, Atkins R, Coresh J, Cohen EP, Collins AJ, Eckardt KU, et al. Chronic kidney disease as a global public health problem: approaches and initiatives - a position statement from Kidney Disease Improving Global Outcomes. Kidney Int 2007; 72: 247–59. doi: 10.1038/sj.ki.5002343
  2. Tonelli M, Wiebe N, Culleton B, House A, Rabbat C, Fok M, et al. Chronic kidney disease and mortality risk: a systematic review. J Am Soc Nephrol 2006; 17: 2034–47.
  3. Levey AS, Astor BC, Stevens LA, Coresh J. Chronic kidney disease, diabetes, and hypertension: what’s in a name? Kidney Int 2010; 78: 19–22. doi: 10.1038/ki.2010.115
  4. Levey AS, Coresh J. Chronic kidney disease. Lancet 2012; 379: 165–80. doi: 10.1016/s0140-6736(11)60178-5
  5. Plantinga LC, Tuot DS, Powe NR. Awareness of chronic kidney disease among patients and providers. Adv Chronic Kidney Dis 2010; 17: 225–36. doi: 10.1053/j.ackd.2010.03.002
  6. Tohidi M, Hasheminia M, Mohebi R, Khalili D, Hosseinpanah F, Yazdani B, et al. Incidence of chronic kidney disease and its risk factors, results of over 10 year follow up in an Iranian cohort. PLoS One 2012; 7: e45304. doi: 10.1371/journal.pone.0045304
  7. Nafar M, Mousavi SM, Mahdavi-Mazdeh M, Pour-Reza-Gholi F, Firoozan A, Einollahi B, et al. Burden of chronic kidney disease in Iran: a screening program is of essential need. Iran J Kidney Dis 2008; 2: 183–92.
  8. Mahdavi-Mazdeh M. Why do we need chronic kidney disease screening and which way to go? Iran J Kidney Dis 2010; 4: 275–81.
  9. Barsoum RS. Chronic kidney disease in the developing world. N Engl J Med 2006; 354: 997–9. doi: 10.1056/nejmp058318
  10. Chow WL, Joshi VD, Tin AS, van der Erf S, Lim JF, Swah TS,  et al. Limited knowledge of chronic kidney disease among primary care patients--a cross-sectional survey. BMC Nephrol 2012; 13: 54. doi: 10.1186/1471-2369-13-54
  11. Swartz MD, Robinson K, Davy T, Politoski G. The role of patients in the implementation of the National Kidney Foundation-Dialysis Outcomes Quality Initiative. Adv Ren Replace Ther 1999; 6: 52–8.
  12. Lorig K, Ritter PL, Villa F, Piette JD. Spanish diabetes self-management with and without automated telephone reinforcement: two randomized trials. Diabetes Care 2008; 31: 408–14. doi: 10.2337/dc07-1313
  13. Wright-Nunes JA, Luther JM, Ikizler TA, Cavanaugh KL. Patient knowledge of blood pressure target is associated with improved blood pressure control in chronic kidney disease. Patient Educ Couns 2012; 88: 184–8. doi: 10.1016/j.pec.2012.02.015
  14. Hemmelgarn BR, Zhang J, Manns BJ, James MT, Quinn RR, Ravani P, et al. Nephrology visits and health care resource use before and after reporting estimated glomerular filtration rate. JAMA 2010; 303: 1151–8.  doi: 10.1001/jama.2010.303
  15. Events Map, World Kidney Day [internet]. [cited 2013 August 30]. Available from: http://www.worldkidneyday.org/events/map?id=913
  16. Waterman AD, Browne T, Waterman BM, Gladstone EH, Hostetter T. Attitudes and behaviors of African Americans regarding early detection of kidney disease. Am J Kidney Dis 2008; 51: 554–62. doi: 10.1053/j.ajkd.2007.12.020
  17. White SL, Polkinghorne KR, Cass A, Shaw J, Atkins RC, Chadban SJ. Limited knowledge of kidney disease in a survey of AusDiab study participants. Med J Aust 2008; 188: 204–8.
  18. Boulware LE, Carson KA, Troll MU, Powe NR, Cooper LA. Perceived susceptibility to chronic kidney disease among high-risk patients seen in primary care practices. J Gen Intern Med 2009; 24: 1123–9.  doi: 10.1007/s11606-009-1086-6
  19. Tan AU, Hoffman B, Rosas SE. Patient perception of risk factors associated with chronic kidney disease morbidity and mortality. Ethn Dis 2010; 20: 106–10.
  20. Ayotte BJ, Trivedi R, Bosworth HB. Racial differences in hypertension knowledge: effects of differential item functioning. Ethn Dis 2009; 19: 23–7.
  21. Fezeu L, Fointama E, Ngufor G, Mbeh G, Mbanya JC. Diabetes awareness in general population in Cameroon. Diabetes Res Clin Pract 2010; 90: 312–8. doi: 10.1016/j.diabres.2010.06.029
  22. Ohmit SE, Flack JM, Peters RM, Brown WW, Grimm R. Longitudinal Study of the National Kidney Foundation’s (NKF) Kidney Early Evaluation Program (KEEP). J Am Soc Nephrol 2003; 14: S117–21. doi: 10.1097/01.asn.0000070155.63971.b2
  23. Vassalotti JA, Li S, Chen SC, Collins AJ. Screening populations at increased risk of CKD: the Kidney Early Evaluation Program (KEEP) and the public health problem. Am J Kidney Dis 2009; 53: S107–14. doi: 10.1053/j.ajkd.2008.07.049
  24. Whaley-Connell AT, Vassalotti JA, Collins AJ, Chen SC, McCullough PA. National Kidney Foundation’s Kidney Early Evaluation Program (KEEP) annual data report 2011: executive summary. Am J Kidney Dis 2012; 59: S1–4.  doi: 10.1053/j.ajkd.2011.11.018
  25. Kurella Tamura M, Li S, Chen SC, Cavanaugh KL, Whaley-Connell AT, McCullough PA, et al. Educational programs improve the preparation for dialysis and survival of patients with chronic kidney disease. Kidney Int 2014; 85: 686–92. doi: 10.1038/ki.2013.369