Illness Perceptions of African-Americans with Chronic Kidney Disease.

African-Americans have the highest rates of chronic kidney disease due to type 2 diabetes (T2DM-CKD) and of progression to end-stage renal disease. The purpose of this study was to describe African-American's perceptions of T2DM-CKD: specifically, perceptions of cause, risk, severity, self-management of T2DM-CKD before and after diagnosis, and overall effect on their lives. Informed by the Common Sense Model of Illness, a cross-sectional qualitative study using purposive sampling was conducted. Findings were that participants did not take T2DM seriously until they had CKD and they also had misperceptions about the cause of T2DM. Participants believed that a family history of diabetes meant nothing could prevent a T2DM onset. In addition, participants viewed primary care providers as not explicitly informing them of their status/risks regarding CKD. The study results identified factors among African-Americans that contribute to the T2DM-CKD progression. This may enhance primary care providers' ability to educate African-Americans, which may lead to more accurate perceptions.

Combined diabetes-renal multifactorial intervention in patients with advanced diabetic nephropathy: Proof-of-concept.

AIMS: To evaluate efficacy of a multifactorial-multidisciplinary approach in delaying CKD 3-4 progression to ESRD. METHODS: Two-year proof-of-concept stratified randomized control trial conducted in an outpatient clinic of a large public hospital system. This intervention, led by a team of endocrinologists, nephrologists, nurse practitioners, and registered dietitians, integrated intensive diabetes-renal care with behavioral/dietary and pharmacological interventions. 120 low-income adults with T2DM and CKD 3-4 enrolled; 58% male, 55% African American, 23% Hispanic. RESULTS: Primary outcome was progression rate from CKD 3-4 to ESRD. Fewer intervention (13%) than control (28%) developed ESRD, p<0.05. Intervention had greater albumin/creatinine ratio (ACR) decrease (62% vs. 42%, p<0.05) and A1C<7% attainment (50% vs. 30%, p<0.05) and trended toward better lipid/blood pressure control (p=NS). Significant differences between 25 ESRD and 95 ESRD-free patients were baseline eGFR (28 vs. 40ml/min/1.73m2), annual eGFR decline (15 vs. 3ml/min/year), baseline ACR (2362 vs. 1139mg/g), final ACR (2896 vs. 1201mg/g), and final A1C (6.9 vs. 7.8%). In multivariate Cox analysis, receiving the intervention reduced hazard ratio to develop ESRD (0.125, CI 0.029-0.54) as did higher baseline eGFR (0.69, CI 0.59-0.80). Greater annual eGFR decline increased hazard ratio (1.59, CI 1.34-1.87). CONCLUSIONS: The intervention delayed ESRD. Improved A1C and ACR plus not-yet-identified variables may have influenced better outcomes. Multifactorial-multidisciplinary care may serve as a CKD 3-4 treatment paradigm.