Abstract: FR-PO1034
Why Am I on Dialysis? Exploring the Gap between Patient Perspectives and Clinical Diagnosis of Kidney Disease in California's Central Valley
Session Information
- Social, Environmental, and Economic Determinants of Kidney Health
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
Authors
- Contreras Nieves, Marimar, Stanford University, Stanford, California, United States
- Powers, Angelina J., Stanford University, Stanford, California, United States
- Jaskulak-Gonzalez, Stefan Andries, Stanford University, Stanford, California, United States
- Banda, Esteban, Stanford University, Stanford, California, United States
- Yu, Xue, Stanford University, Stanford, California, United States
- Kurella Tamura, Manjula, Stanford University, Stanford, California, United States
- Anand, Shuchi, Stanford University, Stanford, California, United States
Background
In the agricultural hub of California’s Central Valley, where the incidence of end-stage kidney disease (ESKD) is amongst the highest in the nation, investigating the discrepancies between patients’ understanding of their kidney disease and their clinical diagnoses holds critical importance, given potential communication barriers including due to language differences, and varying health literacy levels.
Methods
We interviewed 163 patients (range 18-60 year-old) undergoing hemodialysis in Soledad, Salinas, and Fresno, California. We compared the agreement between patients’ reported diagnosis with those documented by clinicians in the CMS 2728. Chi-squared and Mann-Whitney U tests were performed to assess whether the agreement differed by age, gender, and educational background. Educational background was categorized as follows: absence of formal schooling, completion of less than 9th grade, completion of 9th to 11th grade, graduation from high school or obtaining a GED (General Educational Development) equivalent, partial completion of college or attainment of an Associate's degree (AA), and attainment of a college degree or higher.
Results
The survey response rate among those eligible and approached was 80%. The median age of respondents was 49 years (25th, 75th percentile 40, 55 years), 68% were men, and 79% were Hispanic. Patient agreement with clinician documented causes was highest for diabetes (71%) and lowest for hypertension (31%) (Table 1). Agreement rates did not differ by age, gender, or education level.
Conclusion
There was poor concordance between the cause of ESKD documented in clinical records and patients’ understanding, particularly for those with a clinical diagnosis of hypertensive kidney failure or unknown. The findings could indicate both communication gaps, but also inaccuracies in the CMS 2728 categories or the clinician's diagnosis.
Table 1: Cause of ESKD and Agreement Between Patients’ and Clinicians’ Diagnosis
| Clinician designated cause of ESKD | N (%) | Agreement with patient perceived cause (%) |
| Diabetes | 79 (48) | 71 |
| Hypertension | 26 (16) | 31 |
| Glomerular Disease | 11 (7) | 64 |
| Unknown | 33 (20) | 36 |
Funding
- NIDDK Support