The assessment of public perception towards chronic kidney disease in Jordan: a cross-sectional study

Abstract

Objectives

Kidney diseases are considered silent killers due to the lack of well-defined symptoms. Public knowledge about chronic kidney disease (CKD) management has been shown to decrease the risk of CKD onset and progression to end-stage renal disease and renal failure. The main objective of this study was to assess the knowledge of kidney function, CKD symptoms, etiology, prevention and treatment in the general population.

Methods

A cross-sectional study using a validated questionnaire was conducted in Jordan to assess public knowledge of CKD. Public knowledge of CKD was assessed using a questionnaire consisting of 32 knowledge questions, including risk factors, symptoms, treatment, protective measures and kidney function. The knowledge level was classified according to the total score: poor (0–50%), intermediate (51–70%) and good/high (71–100%). Multiple regression analysis was performed to compare knowledge scores (KS) and predict associations with the participants’ baseline characteristics.

Results

The level of knowledge about CKD among the 2181 participants was intermediate. The KS was significantly higher among participants with health issues such as hypertension, diabetes and heart problems, first-degree relatives working in the medical field, majors relevant to health, married, employed, highly educated, high-income and smokers. The main sources of knowledge about CKD were health professionals, TV shows, books and magazines. Multiple regression analysis showed an association between KS and age, sex, functional status, educational level and field, income, smoking status, having a family member/spouse work in the medical field, and knowledge source.

Conclusions

The public level of knowledge about CKD management is greatly influenced by participants’ health and social factors. Thus, improving public knowledge and perception through education and the media will significantly reduce CKD prevalence and incidence.

Key Messages

• Public awareness and educating the public about chronic kidney diseases (CKDs) is essential because of the high prevalence, and increased awareness can contribute to early detection, management and potentially slow down the progression of CKD.

• Creating awareness of the risk factors for CKD enables health policy developers to adopt preventive measures.

• CKD can significantly affect quality of life, and public awareness campaigns can emphasize the impact of CKD on overall well-being, motivating individuals to prioritize kidney health.

Keywords:

• Chronic kidney disease (CKD)
• public perception
• public health

Introduction

Chronic kidney disease (CKD) refers to kidney damage, decreased kidney function or both, and is characterized by a reduced glomerular filtration rate (GFR) of less than 60 mL/min per 1.73 m² for at least 3 months [1]. CKD is an emerging public health problem that affects 5–10% of the world’s population, with increasing prevalence and adverse outcomes [2]. In 2017, the global prevalence of CKD was 9.1% which is approximately 700 million cases [2]. The CKD prevalence in Jordan and the Middle East region is also high; the prevalence of CKD in the general population is 6.8% in Jordan [3], 5.7% in Saudi Arabia [4] and 14.9% in Iran [5].

CKD can lead to end-stage renal disease (ESRD), cardiovascular disease and premature death [6]. Risk factors associated with obesity and diabetes mellitus have increased the number of patients with CKD worldwide [7]. Diabetes and hypertension account for over two-thirds of global CKD cases [8]. Similarly, in Jordan, hypertension and diabetes are responsible for approximately 60% of CKD cases [9]. Accordingly, educating patients about the importance of controlling diabetes and hypertension, since they are the main causes of ESRD, could significantly slow down the deterioration of kidney function and improve the quality of their lives [10].

The global burden of CKD Studies has shown that CKD has emerged as a leading cause of mortality worldwide, causing more than 500,000 deaths since 1990 [11]. Despite this, CKD has received relatively limited global attention and requires effective public health interventions for its prevention and management [11]. Consequently, the prevalence of ESRD has continued to increase worldwide [12]. According to The National Registry of ESRD Annual Report 2013, the number of patients with ESRD increased from 2666 to 4097, and the number of deaths increased from 125 to 520 [11]. Additionally, there were 6316 patients that were treated in dialysis units by the end of 2019, with approximately 750 new cases in the same year [13].

Most CKD patients are unaware of the severity of their disease [14]. Lack of knowledge about CKD, as well as negative attitudes and practices, has resulted in a delayed diagnosis of CKD [14]. Similarly, other studies have shown that many patients with CKD do not have enough knowledge to manage their fluid and diet [15,16], and subsequently accelerate the development of ESRD, increase dialysis cost and consequences of the disease, which negatively affects the health outcome. Interestingly, other studies showed that patients’ education can delay the progression of renal disease and improves survival [16]. Therefore, increasing awareness by health care providers, especially among patients who are at high risk of developing CKD, could be an important tool in preventing or delaying the incidence of CKD in susceptible individuals [18].

Educational programs carried out by healthcare providers enhance CKD patients’ satisfaction, increase self-care and overcome various misconceptions regarding diet, medication and dialysis [17]. In addition, patients’ education and awareness of CKD can retard the progression of CKD and improve survival, illness-related complications, and quality of life [19]. Hence, knowledge and adherence to treatment are major interventions to slow down the progression of CKD, as well as to prevent complications of CKD. Therefore, public knowledge of CKD management is important for the early diagnosis and treatment of the disease.

This study aimed to assess the knowledge of kidney function, CKD symptoms, etiology, prevention and treatment in the general population. Specifically, this study was conducted to answer the following questions:

• What is the public level of knowledge about CKD management and prevention in Jordan?

• What is the relationship between the sociodemographic characteristics of participants and their KSs?

• What is the relationship between participants’ health information and KSs?

• What are the most common sources of knowledge about CKD according to the participants?

Methods

This observational, analytical cross-sectional study consisted of two stages. Stage 1: preparation and validation of the CKD questionnaire and stage 2: a cross-sectional survey to assess Jordanians’ public knowledge of CKD.

Study design

The first draft of the questionnaire was prepared and modified by the research team using a previously published validated questionnaire prepared by Gheewala et al. [20]. The questionnaire was modified as follows: (1) additional risk factors and symptoms were added to the existing ones. (2) New sections were introduced to the previously published questionnaire regarding the treatment and the protective measures for CKD. The new information was obtained from the National Kidney Foundation website (www.kidney.org). The modified version of the questionnaire was assessed for validity and reliability as follows; for validity, the questionnaire was evaluated and validated by the research team and experts in the field (two renal physiologists, and a nephrologist) to ensure the robust of the selected questions. For reliability, the questionnaire was sent to 36 participants in a pilot study. The reliability coefficient Cronbach’s alpha was calculated, and it was 0.962, this value indicates an excellent reliability for the survey items.

The final version of the questionnaire consisted of two parts. The first part collected socio-demographic information about the participants, including (age, sex, employment status, educational level, educational field, social status, place of residence, income, smoking status, family history of CKD, medical conditions and the source of knowledge about kidneys). The second part included knowledge questions on kidney function, CKD risk factors, symptoms, treatment and protective measures to prevent CKD.

The final version of the questionnaire consisted of 32 questions. The answers to the questions were multiple-choice options ‘True,’ ‘False’ and ‘I don’t know.’ The correct answer (True) was marked as 1, whereas the incorrect response and ‘I do not know’ option were marked as 0. The final version of the questionnaire was distributed to eligible individuals by the research team.

Since the respondents were all Arabic-speaking, the survey was translated into Arabic. The translation process consisted of two stages: (1) translating the questionnaire into the Arabic language and (2) back-translating the Arabic version into English using forward-backward translation techniques [21]. To determine the minimum required sample size for this study, which was 385, the Raosoft sample size calculator was used with a confidence interval of 95% and a 0.5 precision [22].

Data collection and sampling

The validated questionnaire was used to assess the public knowledge of CKD. The questionnaire was prepared using Google forms, and it was distributed online mainly in the Central and Northern territories of Jordan where most of people are living (about 63% in the central and 28% in the north) [23]. To increase the statistical robustness of this study, we included 2181 participants.

At the beginning of the survey, participants were requested to indicate their consent to participate in the study by selecting ‘yes.’ They were explicitly informed that participation in the study was voluntary and optional, and assured that their information would be treated with confidentiality. An introductory paragraph illustrates the meaning of CKD and the aim of the study. Participants were asked to fill out the survey and choose the right answer based on their knowledge about CKD. As mentioned earlier, the correct answer was scored as 1 and the wrong answer was scored as 0. The correct answers were expressed as percentages for analysis. The knowledge level was classified according to the total score of each section: 0–50% scored as ‘poor,’ 51–70% scored as ‘intermediate’ and 71–100% scored as ‘Good/High’ [24]. Notably, the STROBE cross-sectional reporting guidelines were checked to improve the study quality [25]. It is noteworthy that the patients and the public were not involved in designing, conducting, reporting or disseminating the plans for this research.

Inclusion criteria

The inclusion criteria were as follows: (1) adults aged 18 years or above and (2) able to read and understand Arabic. The exclusion criteria were as follows: (1) non-Jordanians and (2) individuals with affected cognitive ability.

Statistical analysis

The survey data were analysed using IBM SPSS software (2020) (SPSS Inc., Chicago, IL). Descriptive and analytical statistics were used to extract the required statistical measures. Categorical variables, including sociodemographic information and knowledge, are expressed as frequencies and percentages. ANOVA and independent t-tests were used to study the effect of the baseline sociodemographic and health information of the participants on their CKD KS within each category. Multivariable linear regression analysis was performed to predict CKD KS based on the participants’ baseline characteristics (β coefficient: 95% CI), p value <.05 was considered statistically significant. The RStudio IDE programming language for statistical computing and graphics version 4.0.3 (10-10-2020) was used to prepare Figure 1 (Venn shape).

Figure 1. Venn diagram representing the public source of knowledge about CKD Venn shape showed the different sources of knowledge about CKD. The numbers represent the participants who chose one or more source of knowledge. TV, Books, Social media and internet, and healthcare professionals. Among the 2181 participants, 1207 identified their source of knowledge.

Results

The participant’s baseline sociodemographic and health information

A total of 2181 individuals participated in this study. The sociodemographic and health information of the participants are presented in Table 1. Most of the participants (69.7%) were from 18 and 35 years old. The majority were males (74.8%). Concerning the participant’s employment status, approximately 40% were employed. A large share of participants (89.1%) had undergraduate degree. About 14% of the surveyors’ educational field was related to health. 30.9% of the participants were married. Regarding the place of residence, approximately 88% were living in urban (cities). Of note, most of the participants (71%) had income less than 1500 USD/month. Among the participants, about 65% were smokers.

Table 1. Baseline sociodemographic, health information and CKD knowledge score.

Sociodemographic information of the participants	Number (%) (total 2181)	Knowledge score^a Mean (SD)	ANOVA p Value Eta-squared Degree of freedom (df)
Age (years)
18–35	1520 (69.7)	21.7 (6.6)	0.187
36–49	344 (15.8)	21.6 (7.2)	0.002
50–64	300 (13.8)	22.4 (4.4)	3
65≤	17 (0.8)	19.8 (10.7)
Sex			0.097
Male	1631 (74.8)	21.6 (6.5)	0.091
Female	550 (25.2)	22.14 (6.6)	1
Employment status			<.001*
Employed	851 (39.0)	22.9 (6.5)	0.021
Unemployed	1330 (61.0)	21.0 (6.4)	1
Educational level			<.001*
High school or less	238 (10.9)	16.1 (7.8)	0.091
Undergraduate	1943 (89.1)	22.4 (6.0)	1
Educational field			<.001*
Relevant to health	303 (13.9)	26.0 (6.0)	0.067
Not related to health	1878 (86.1)	21.1 (6.4)	1
Social status
Married	674 (30.9)	22.5 (7.5)	<.001*
Not married (single, divorced, widowed)	1507 (69.1)	21.4 (6.0)	0.006
			1
Place of living			<.001*
Rural (villages)	266 (12.2)	23.6 (8.2)	0.012
Urban (cities)	1915 (87.8)	21.5 (6.2)	1
Income (USD)/month			<.001*
Less than 1500	1548 (71.0)	20.6 (6.6)	0.08
More than 1500	633 (29.0)	24.6 (5.4)	1
Smoking status			<.001*
Non-smoker	771 (35.4)	20.4 (7.9)	.022
Smoker	1410 (64.6)	22.5 (5.5)	1
Do you have a family member or spouse who works in the medical field?			<.001*
Yes	438 (20.1)	22.9 (8.1)	0.08
No	1743 (79.9)	21.5 (6.0)	1
Have you ever been diagnosed with any of the following medical conditions?
Kidney problems (stones, failure, infection, proteins or blood in the urine, etc.)
Yes	126 (5.8)	20.8 (6.7)	0.107
No	2055 (94.2)	21.8 (6.5)	0.001
			1
Hypertension
Yes	389 (17.8)	23.0 (4.6)	<.001*
No	1792 (82.2)	21.5 (6.9)	0.008
			1
Diabetes
Yes	352 (16.1)	23.0 (4.3)	<.001*
No	1828 (83.8)	21.5 (6.9)	0.006
			1
Heart problems (heart attack, arrhythmia, etc.)
Yes	191 (8.8)	26.0 (5.9)	<.001*
No	1989 (91.2)	21.3 (6.5)	0.04
			1
Do you have a family history of kidney problems (stones, failure, infection, proteins or blood in the urine, etc.)?
Yes	239 (11.0)	21.0 (7.2)	0.053
No	1942 (89.0)	21.8 (6.4)	0.002
			1

* Significant (p value <.05), the significance is for the higher level of knowledge.

a Knowledge score (out of 32).

The participants were also asked if they had a family member or a spouse who worked in the medical field, which could affect their knowledge, results showed that about 20% of the participants answered ‘yes.’ The participant’s baseline health information was included; 5.8% of them were diagnosed with kidney problems such as stones, failure, infection and protein in the urine, 17.8% had hypertension, 16.1% had diabetes and 8.8% had heart problems. Furthermore, 11% of the surveyors had a family history of kidney disease.

The public knowledge about kidney functions, CKD etiology, symptoms, treatment and protection

Table 2 shows the public knowledge about kidney function, CKD risk factors, symptoms, treatments and protective measures. The participants were asked to respond to every 32 items with ‘True,’ ‘False’ or ‘I don’t Know.’

Table 2. The public knowledge about kidney functions, chronic kidney diseases etiology, symptoms and treatments.

	Knowledge items				Knowledge score (%)^a	Knowledge description
	Total knowledge score	Answers (%)			21.7/32 (65.9)	Intermediate
No.	What are the main functions of the kidneys?	True^b	False	I do not know	2.7/5 (54.7)	Intermediate
1	The kidneys clean the blood from toxins and turn waste products into urine	92.8	1.6	5.6
2	Kidneys help in producing RBCs	19.4	33.9	46.7
3	The kidneys help maintain blood pressure	58.0	6.5	35.5
4	The kidneys help maintain the level of ions and salts in the blood	81.5	2.6	15.9
5	The kidneys help maintain healthy bones	21.6	16	62.31
	What are the risk factors for chronic kidney disease?				8.1/12 (67.6)	Intermediate
6	Diabetes	51.5	5.9	42.6
7	Hypertension	61.1	6.4	32.5
8	Heart problems such as heart failure or a heart attack	24.9	11.3	63.8
9	Excessive stress	42.8	10.3	47
10	Obesity	77.8	7	15.2
11	Eat unhealthy foods such as fast food	81.8	4.3	13.9
12	Aging	67.7	8.5	23.8
13	Over-the-counter medications such as Ibuprofen and pain relievers	84.0	3.4	12.6
14	Nutritional supplements	54.6	12.6	32.8
15	Prolonged urine retention	90.5	1.5	8
16	Repeated kidney infections	88.9	1.2	9.9
17	Inherited kidney disorders	85.4	2.8	11.9
	What signs and symptoms would a person experience if they had chronic kidney disease?				3.8/6 (49.3)	Poor
18	Swollen feet and ankles due to water retention (excess water in the body)	68.1	1.8	30.1
19	Blood in urine	81.9	3.9	14.2
20	Nausea and vomiting	43.1	9.7	47.2
21	Loss of appetite and weight loss	42.3	9.2	48.5
22	Increased feeling of fatigue and tiredness	55.2	2.4	42.4
23	Change in the amount and frequency of urination	85.3	1.7	13
	Which of the following statements applies to treating chronic kidney disease?				2.8/4 (68.7)	Intermediate
24	One healthy kidney is sufficient for a person to lead a normal life	89.8	3	7.2
25	Medicines that treat chronic diseases such as high blood pressure and diabetes contribute to reducing the progression of chronic kidney disease	53.9	9.2	36.9
26	Dialysis and transplantation are only needed when the kidneys lose at least 85% of their function	59.8	5.3	34.9
27	Proper diet and healthy life style may help slow the progression of kidney disease	71.1	1.6	27.1
	Which of the following will protect your kidneys from developing chronic kidney disease in the future?				4.3/5 (85.3)	Excellent
28	Adopting healthy lifestyle such as eating healthy and exercising	93	0.6	6.4
29	Drinking plenty of water to avoid dehydration	94.2	1.1	4.7
30	Limit the intake of caffeinated beverages	80	11.5	8.5
31	Treating risk factors such as diabetes and hypertension	77.2	11.2	11.7
32	Regular check on kidney functions	82.3	9.3	8.4

^a Knowledge score and level. Knowledge score classification: 0–50%: poor level of knowledge. 51–70%: intermediate level of knowledge. 71–100%: excellent level of knowledge.

^b True is the correct answer.

Regarding kidney function (Table 2, items 1–5), 92.8% agreed that kidneys clean the blood from toxins and turn waste products into the urine, 81.5% confirmed that kidneys help to maintain the level of ions and salts in the blood, 58% thought that kidneys help to maintain blood pressure. However, only 21.6% knew the information that kidneys help to maintain healthy bones, and only 19.4% knew that kidneys help in producing RBC.

CKD risk factors (Table 2, items 6–17), the percentage of the respondents who answered correctly was as follows (highest to lowest): prolonged urine retention (90.5%), repeated kidney infections (88.9%), inherited genetic disorders (85.4%) and over-the-counter medications, such as ibuprofen and pain relievers (84%), unhealthy foods (81.8%), obesity (77.8%), aging (67.7%), hypertension (61.1%), nutritional supplements (54.6%) and diabetes (51.5%). To lesser extent, excessive stress (42.8%) and heart problems (heart failure or a heart attack) (24.9%).

For CKD symptoms (Table 2, items 18–23), the percentage of the participants who answered correctly was as follows: change in the amount and frequency of urination (85.1%), blood in the urine (81.9%), swollen feet and ankles due to water retention (68.1%), increased feeling of fatigue and tiredness (55.2%), nausea and vomiting (43.1%), loss of appetite and weight loss (42.3%).

The participants’ knowledge of CKD treatment is summarized in Table 2 (items 24–27). The percentage of respondents who answered correctly the following statements were: one healthy kidney is sufficient for a person to lead a normal life (89.9%), proper diet and healthy lifestyle may help slow the progression of kidney disease (71.1%), dialysis and transplantation are only needed when the kidneys lose at least 85% of their function (59.8%), medicines that treat chronic diseases such as high blood pressure, and diabetes contribute to reducing the progression of CKD (53.9%).

Finally, the participants’ opinions regarding future protective measures against CKD are reported in Table 2 (items 28–32). Their responses were: drinking plenty of water to avoid dehydration (94.2%), adopting a healthy lifestyle such as eating healthy and exercising (93.0%), regular checks on kidney function (82.3%), limiting the intake of caffeinated beverages (80.0%), treating risk factors such as diabetes and hypertension (77.2%).

The baseline characteristics affect the public knowledge scores

The impact of sociodemographic and health information on the participants’ KSs (out of 32) is shown in Table 1. There was no significant difference (p > .05) in KS between the different age groups, and between males and females. Interestingly, the number of employed participants (KS = 22.9) was significantly (p < .05) higher than that of the unemployed (KS = 21.0). Educational level influenced KS; participants with undergraduate degree had significantly higher levels of knowledge (KS = 22.4) compared to participants with high school or less (KS = 16.1). This indicates an important link between educational level and CKD knowledge. The educational field also affected participants’ KS, results showed that KS is significantly higher in participants whose educational field is relevant to health (KS = 26.0) than in others (KS = 21.1).

The social status of the participants had a significant effect on their level of knowledge; married individuals had significantly higher knowledge levels (KS = 22.5) than unmarried individuals (KS = 21.4). Further, the place of living also impacted KS; participants living in rural areas had a significantly higher level of knowledge (KS = 23.6) than those living in urban areas (KS = 21.5).

Noteworthy, the total income of the participants significantly affected the knowledge level, KS was higher among participants with income >1500 USD/month (KS = 24.6) compared to (KS = 20.6) in those with lower income (<1500 USD/month). Interestingly, the smoking status of participants affected their level of knowledge. Smokers had a significantly higher level of knowledge (KS = 22.5) than non-smokers (KS = 20.4).

Individuals with a family member or a spouse who were working in the medical field had significantly higher KSs (KS = 22.9) than others (KS = 21.5).

The effect of participants’ health conditions on their knowledge level was also studied, results showed that participants with hypertension, diabetes and heart problems had a significantly higher level of knowledge (KS = 23.0, 22.9 and 26.0, respectively) than others (KS = 21.5, 21.5 and 21.3, respectively). Notably, a family history of kidney problems among the participants had no significant effect on KS. The Eta-squared and the degree of freedom (df) values are added to Table 1 to provide information about the strength of the relationship between the independent and dependent variables, in addition to the statistical difference, the Eta squared values also reflect the magnitude of the difference. The df measures the variability between groups.

The public knowledge description

The participants’ knowledge descriptions are shown in Table 2. The total KS for the participants was 21.7 out of 32 (65.9%), indicating an intermediate level of knowledge. We have further provided a description of CKD for each field. Results showed that participants had an excellent level of knowledge about CKD protective measures (KS = 4.3/5, 85.3%). Considering the kidney’s main function, CKD risk factors and CKD treatment, participants showed an intermediate level of knowledge KS = 2.7/5 (54.7%), 8.1/12 (67.6%) and 2.8/4 (68.7%), respectively. However, the participant’s knowledge of the CKD signs and symptoms was poor (KS = 3.8/6, 49.3%).

The public sources of knowledge about CKD

The participants’ sources of knowledge about the kidneys and CKD were evaluated. Results in Table 3 and Figure 1 highlighted the most common sources of knowledge as follows: health-related professionals (38.3%), Internet and social media (37.8%), TV shows (37.1%) and books and magazines (21.8%). Figure 1 is Venn shape showing the number of participants who chose one or more sources of knowledge. Out of the 2181 participants who answered the survey, 1207 (55.34%) identified at least one source of knowledge about CKD. The largest share of these participants (271/1207, 22.45%) referred to all four different sources to gain information about CKD.

Table 3. The public source of knowledge about CKD.

What sources of knowledge do you have about kidneys?	Number (%) (total 2181)	Knowledge score^a Mean (SD)	ANOVA p Value Eta-squared Degree of freedom (df)
TV shows			<.001*
Yes	810 (37.1)	23.6 (5.9)	0.045
No	1367 (62.7)	20.7 (6.7)	1
Books and magazines			<.001*
Yes	475 (21.8)	25.3 (6.4)	0.082
No	1699 (77.9)	20.8 (6.2)	1
Internet and social media (Facebook, Twitter, Instagram)
Yes	825 (37.8)	22.0 (7.1)	0.207
No	1341 (61.5)	21.7 (6.1)	0.001
			1
Health related professionals (doctor, pharmacist, nurse, caregiver)
Yes	835 (38.3)	23.5 (5.7)	<.001*
No	1339 (61.4)	20.7 (6.8)	0.043
			1

* Significant (p value <.05), the significance is for the higher level of knowledge.

^a Knowledge score (out of 32).

The sources of knowledge that significantly affected the participants’ KS were books and magazines, followed by TV shows, health-related professionals, and to less extent the Internet and social media (KS = 25.3, 23.6, 23.5 and 22.0), respectively. The Eta-squared and the df values were also added to Table 3.

Multiple regression analysis of the public knowledge score

The date further analysed the relationship between KS and participant characteristics using multiple regression analysis. Table 4 shows only the significant values (p < .05). Multivariate analysis found higher KS values associated with the age category of 50–64 years. Participants’ gender, employment status, educational field, income and smoking status were independently associated with higher KS. Educational level was also associated with higher KS. Having a family member or spouse working in the medical field was independently associated with higher KS. Interestingly, hypertension was independently associated with KS. Finally, the sources of knowledge about the kidney, such as TV shows, books and magazines, the Internet and social media, and health-related professionals were all independently associated with KS.

Table 4. Multiple regression analysis of public knowledge score and the participants’ baseline characteristics.

Sociodemographic information of the participants	R^2 value	β coefficients (95% CI)	p Value* <.05
Age (years)
18–35^a	0	−0.119	<.001
50–64
Sex
Male^a	0.001	0.184	<.001
Female
Employment status
Unemployed^a	0.021	−0.076	.007
Employed
Educational level
High school or less^a	0.091	0.247	<.001
Undergraduate
Educational field
Relevant to health^a	0.067	−0.179	<.001
Not related to health
Total income (USD)/month
Less than 1500^a	0.08	0.121	<.001
More than 1500
Smoking status
Non-smoker^a	0.022	−0.201	<.001
Smoker
Do you have a family member or spouse who works in the medical field?
Yes^a	0.008	0.111	<.001
No
Hypertension
Yes^a	0.008	−0.077	.021
No
What sources of knowledge do you have about kidneys?
TV shows
Yes^a	0.045	−0.071	.013
No
Books and magazines	0.082	−0.168	<.001
Yes^a
No
Internet and social media (Facebook, Twitter, Instagram)
Yes^a	0.001	0.102	<.001
No
Health related professionals (doctor, pharmacist, nurse, caregiver)
Yes^a	0.043	−0.107	<.001
No

^a Reference, R for the model = 0.511.

* p value <.05: significant.

Discussion

The main goal of this study was to define knowledge gaps regarding CKD among the general population; hence, we evaluated the knowledge and awareness of the Jordanian community regarding CKD and its associated risk factors. This study is among the very few studies in Jordan that discuss the public knowledge of CKD. It is of great importance locally and globally because it provides an overview of the different fields of knowledge that the public needs to know in order to improve their knowledge about CKD. In addition, this study helps in the early diagnosis of CKD, participates in reducing CKD treatment costs, and minimizes quality of life disturbances. This study has advantages over previous studies because of its large population size, comprehensive and validated questionnaire, analytical approach, and results.

Herein, we found that the overall public knowledge about CKD was intermediate. Several determinants played a role in this knowledge, such as educational level and field, employment and marital status, income, and health issues including hypertension and diabetes.

Public knowledge of kidney function was intermediate. Participants demonstrated good knowledge regarding the role of the kidneys in cleaning the blood from toxins and turning waste products into urine, maintaining blood pressure, and maintaining the level of ions and salts in the blood. They had more correct answers compared to previous reports [20,26]. For example, 58.0% of the participants in our study correctly answered the role of kidneys in maintaining blood pressure compared to 26.4% reported in a previous study conducted in Australia [20]. Nevertheless, our population sample had poor knowledge regarding the role of kidneys in maintaining healthy bones and CKD production; this result is in line with previous findings that showed only 14.3% of the general population correctly answered the role of kidneys in healthy bones [20].

Overall, the respondents’ knowledge of CKD risk factors was intermediate. Our results showed that approximately 61% of the respondents correctly identified hypertension as a risk factor for CKD. This percentage was close to that reported one in South-West Nigeria, which was approximately 55% [27], but higher than previous findings: 44% in Hong Kong [28], 38% among the Australian population [20], and only approximately 14% in the Iranian population [29].

Diabetes was also reported as a risk factor for CKD; herein, 52% of the surveyors correctly identified diabetes as a risk factor for CKD, and this finding is consistent with the previous findings, with reported percentages ranging from 44 to 61% [20,27,28].

Regarding the public knowledge of CKD symptoms, results showed poor knowledge and understanding of CKD symptoms, which highlights the importance of public health education in educating individuals susceptible to CKD about the symptoms and signs of CKD in the early stages and stress the importance of regular renal care counselling [30,31].

Public knowledge about CKD treatment was intermediate. Most of the participants knew that proper diet and healthy lifestyle might help slow down the progression of kidney disease. However, less know that medications that are used to treat chronic diseases such as high blood pressure and diabetes contribute to slowing down the progression of CKD [32], and few knew that dialysis and transplantation are only needed when kidneys lose at least 85% of their function [33]. This implies that public knowledge about CKD treatment needs to be improved, since individuals with adequate knowledge and understanding of CKD are more likely to follow their medical treatments [34].

Interestingly, the overall public knowledge of the protective measures that protect the kidneys from CKD development was excellent. The majority of participants were aware that adopting a healthy lifestyle, drinking plenty of water to avoid dehydration, and limiting the intake of caffeinated beverages could protect the kidneys from developing CKD in the future [35].

Our data showed that KSs were significantly lower among unemployed, less educated and low-income individuals than among employed, educated and high-income individuals. This result is consistent with a previous study from India, which showed a higher KS for CKD among employed and educated respondents [36]. Furthermore, another study from Singapore reported that respondents with older age, lower educational status and lower monthly income were more likely to have limited knowledge about CKD [37].

Individuals who are in contact with the health sector, such as having a first-degree relative working in the medical field or having chronic illnesses such as hypertension and diabetes, are more knowledgeable about CKD than others. This suggests that health education regarding CKD prevention and management is critical in targeting unemployed, less-educated and low-income individuals [38,39].

Lastly, according to our respondents, books and magazines were the main sources of knowledge about CKD, whereas the Internet and social media were the least. This indicated that either the shortness of such medical shows about CKD or people are not interested in watching these types of medical shows. Health-related professionals are highly encouraged to use social media and establish an information database to educate the public about the different aspects of CKD, which has to be in a simple and attractive way, and of course in different languages [40].

National programs to educate the public about the association between unmanaged diabetes/hypertension and CKD could improve awareness of the disease, associated risk factors and consequences in susceptible individuals. In USA, Kidney Early Evaluation Program (KEEP) organized by the National Kidney Foundation targets individuals with diabetes and/or hypertension for educational programs and early CKD screening [41,42]. The participants in the KEEP were provided with adequate information regarding the association between hypertension/diabetes and CKD and encouraged to follow up with their clinicians for early detection, prevention and treatment of risk conditions. Follow-up studies showed that participation in KEEP was associated with significantly higher rates of pre-ESRD nephrologist care, peritoneal dialysis, pre-emptive transplant wait listing, transplantation, and with a lower risk for mortality, suggesting that kidney disease screening and education program were associated with higher rates of ESRD preparation and survival [30,31,43].

The main strengths of this study are the large and diverse population sizes, which enable the generalizability of the study results. A well-structured questionnaire that covered the participants’ sociodemographic and health information and knowledge about CKD comprehensively participated in the research outcomes. The analytical approach followed to interpret the results was used to produce solid conclusions about public knowledge of CKD.

However, different types of bias, such as selection bias, recall bias and gender difference (males participants are more than females) have limited this study. Our study is a self-report study, which makes it susceptible to participants’ mood and state of feeling.

To summarize, the overall knowledge of the Jordanian public regarding CKD and its risk factors was intermediate, highlighting the importance of educating Jordanian populations and the necessity for healthcare providers to improve their communication with the public regarding CKD and its associated risk factors, especially diabetes and hypertension.

Conclusions

The level of knowledge and understanding of CKD and its associated risk factors are influenced by several determinants. Some health and social determinants positively influenced KS and knowledge levels. Health determinants include health conditions, educational field related to health, and having a first-degree relative work in the medical field. Social determinants include such as high educational level, high income, employment and marital status. Hence, participants with high qualifications, who are health-related, are more knowledgeable about CKD management than the rest. The current study findings demonstrate that developing health education to prevent CKD is crucial, and this will help healthcare providers and policymakers to pay more attention to understanding the extent of knowledge and attitude towards CKD and thus provide relevant education to patients and family members.

Author contributions

The author contributions to the paper are as follows: A.A.: conceptualization, investigation, writing the original draft, review and editing. E.A.: project administration, conceptualization, investigation, supervision, writing of original draft, review and editing. L.A.: wrote the original draft, reviewed and edited the manuscript. A.Q.: methodology, validation, review and editing. H.A.: statistical analysis and manuscript editing.

Ethical approval

This study was approved by the Institutional Review Board (IRB) Committee of the University of Jordan (Ref.: 19/2023/367), with no need for written consent for participation, which was optional. Participants provided verbal informed consent and they were informed earlier that participation was optional, and that all their information was confidential and would be used only for research purposes.

Consent form

According to the IRB committee regulations at the University of Jordan, written consent is only mandatory for studies involving sensitive information, such as patient data, and in the survey studies the participants consent is contained in their participation. Before participants could complete the questionnaire, they had to read an introductory paragraph outlining the study’s ethical guidelines. This included details about the study and a statement confirming the confidentiality of participants’ information, which would be used solely for research purposes, and they could proceed with the questionnaire only if they agreed to participate in the study.

Acknowledgements

The authors would like to thank Dr. Motaz Obeidat for evaluating the questionnaire as a nephrologist. Special thanks to Dr. Amani Alhadid for help in distributing the survey. All respects and gratitude to everyone who participated in this study for filling out the survey or distributing it.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data are available by the corresponding author upon request.

Additional information

Funding

No funding was received.