Trends and Independent Correlates of Chronic Kidney Disease Awareness in US Adults: NHANES 1999–2020

Abstract – Introduction: Chronic kidney disease (CKD) is a public health and economic burden with serious adverse health outcomes and extremely low awareness. Current evidence on independent correlates of CKD awareness is inconsistent and recent data examining time trends of CKD awareness in the USA are dated. The aims of our study are to examine time trends in CKD awareness from 1999 to 2020 and examine independent correlates of CKD awareness in US adults with CKD. Methods: We analyzed data from the National Health and Nutrition Examination Survey (1999–2020). The study sample consisted of 9, 825 US adults with CKD. The primary outcome was CKD awareness. Independent correlates included sociodemographic, comorbidity and clinical variables. Unadjusted and adjusted logistic regression models were used to examine the association of CKD awareness and covariates. Results: CKD awareness did not change significantly from 1999 (9.4%) to 2020 (10.8%). Fully adjusted model showed male sex (OR 1.41, 95% CI [1.09, 1.84]), non-Hispanic black race/ethnicity (OR 1.73, 95% CI [1.36, 2.20]), multimorbidity (OR 2.92, 95% CI [2.01, 4.25]), having high-risk CKD (OR 2.06, 95% CI [1.57, 2.70]), and very high-risk CKD (OR 5.38, 95% CI [3.99, 7.25]) were associated with higher likelihood of CKD awareness. However, age, education, and insurance were not significantly associated with CKD awareness. Discussion: During the 2 decades examined in this study, CKD awareness remains extremely low. More prospective studies are needed to understand patient-level barriers to CKD awareness and provider-level barriers to CKD screening, CKD education, and knowledge transfer.