Abstract Body (Do not enter title and authors here): Background: There is growing recognition of the complex interplay between cardiometabolic (CM) risk factors, chronic kidney disease (CKD), and cardiovascular disease (CVD). In 2023, the American Heart Association introduced the concept of cardiovascular-kidney-metabolic (CKM) syndrome to highlight these interconnections. Disease unawareness remains a major barrier to effective management. Little is known about CKD awareness among individuals with CM risk factors or CVD—groups at particularly high risk.
Objectives: To evaluate CKD unawareness among US adults with CM risk factors and CVD between 2011 and 2020.
Methods: We identified adults with CKD using the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2020. Estimated glomerular filtration (eGFR) rate was calculated using the race-free CKD-EPI 2021 creatinine equation. Presence of CKD was defined as eGFR <60 (ml/min/1.73m²) or urine albumin/creatinine ratio ≥ 30 mg/g. Hypertension, diabetes, and hyperlipidemia were identified through biometric data or self-reported diagnoses, while obesity was defined using body mass index. CVD was determined based on self-reported history of coronary artery disease, angina, stroke, myocardial infarction, or heart failure. CKD unawareness was defined as a “no” response to the question “Ever told you had weak/failing kidneys?”. Survey-weighted linear regression models were fit to determine changes over the study period.
Results: Among US adults with CM risk factor, CKD unawareness remained high and unchanged between 2011-2012 and 2017-2020 (89.4% [95% CI, 86.3%–92.5%] to 88.6% [86.7%-90.5%], p=0.21). Among adults with CVD, CKD unawareness decreased from 86.5% (82.1%–90.8%) to 75.1% (69.5%–80.7%) (p=0.0037) (Figure). There were no differential trends across subgroups (age, sex, education level, family income-to-poverty ratio). However, CKD unawareness worsened for non-Hispanic black adults from 66.7% (56.9%–76.5%) to 76.7% (68.2%–85.1%) (p=0.004 for interaction) while improving for other ethnicity groups.
Conclusions: In this national study, 9 in 10 adults with CM risk factors were unaware that they had CKD, with no improvement between 2011 and 2020. Although awareness has modestly improved among individuals with CVD, approximately 75% remain unaware of their CKD diagnosis. These findings highlight a critical gap in disease recognition and emphasize the urgent need for national efforts to improve CKD awareness among adults with or at risk for CVD.