Knowledge, Attitudes, and Practice of Diabetic Patients towards Prevention and Early Detection of Chronic Kidney Disease: A Cross Sectional Study from Palestine

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Amani Abu-Alrub
Aya Mufleh
Israa Dawrazeh
Farah Sadder
Laila Ayoub
Leen Nasrallah
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Background: Diabetes mellitus (DM) has been identified as the epidemic of the century not only due to its spiking prevalence, but also for its chronic complications and high mortality. Chronic kidney disease (CKD) is a common complication which is on the rise globally. Recently, researchers have directed their efforts to find methods to prevent the progression of both of these epidemics. Simultaneously, the aim of this study was to assess diabetic patients' knowledge, attitudes and practices towards prevention and early detection of CKD. Methods:A comparative cross-sectional study was conducted in Al-Makhfia governmental diabetes Primary Health Care (PHC) clinic in Nablus city from May to December 2015. The CKD Screening Index and the 8-item Morisky Medication Adherence Scale were used to evaluate diabetic patients’ knowledge, attitudes and practices. Patients with already existing CKD were excluded. Statistical analysis was performed by using Statistical Package for Social Sciences (SPSS) program. Results:The questioner was completed by 380 respondents. The results showed that the mean knowledge score was 12.06 (SD= 4.79), with 80.3% of them answered positively on the fact that DM is a risk factor for CKD. Many sociodemographic and clinical variables affected the level of knowledge; the most significant were age and high level of education with a P value of 0.001 for both. The mean attitude score was 10.023 (SD= 1.588), with 100% of patients affirming the importance of keeping themselves healthy. Among all variables affecting the attitude, male gender and higher educational level were the most significant with a median score of 11 and a P value of 0.000. Our sample showed a mean score of practice of 35.31 (SD= 4.33) with a very good practice toward their medication use. The major effect on practice was related to the high level of education with a median score and a P value of 39 and 0.002 respectively. Finally, by reviewing the answers on Morisky adherence scale, we found that most of our patients were adhered to their antidiabetic regimen with a mean score of 6.29 (SD= 1.55). With a P value of 0.005 age was the most significant variable affecting the adherence level. Conclusions:Our research revealed average overall CKD knowledge. Although diabetics were aware of the possibility of developing CKD, information was lacking about several other risk factors and main signs and symptoms of CKD. A CKD awareness program is strongly recommended specially in the high risk populations like the one in our study. Efforts of health team members, especially Pharm D fellows should be focused on emphasizing the importance of patient counseling and education to limit the spread of such difficult epidemics.