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New Research Illustrates How to Drive Earlier Diagnosis and Treatment of Kidney Disease

A new survey in partnership with the National Kidney Foundation finds that discussions between patients and providers, and patient activation, are key to helping high-risk patients take preventive actions to manage their kidney health

New research published in The American Journal of Accountable Care by Phreesia, in partnership with The National Kidney Foundation (NKF), found that even eight years after patients are diagnosed with diabetes and/or hypertension, many do not know that these conditions put them at high risk for chronic kidney disease (CKD). The study finds that discussions between a patient and their providers and patient activation play a significant role in detecting and preventing CKD, one of the leading causes of death in the United States.

In a month-long survey of 4,445 patients with diabetes and/or hypertension, two of the most prevalent risk factors for CKD, results showed a significant gap in awareness—two in three of these high-risk patients were not aware of their risk for kidney disease. The study uses the Patient Activation Measure® (PAM®) to evaluate surveyed patients' knowledge, skills and confidence in managing their own health. Highly activated patients feel comfortable advocating for themselves and asking for support from their care team to manage their own health, while low-activation patients need more targeted support and resources. The study found that, of those surveyed:

  • 70% of highly activated patients with diabetes have discussed kidney health with their healthcare provider, compared to just 38% of low-activation patients with diabetes.
  • 51% of highly activated patients with hypertension have discussed kidney health with their healthcare provider, compared to just 7% of low-activation patients with hypertension.

Critically, the study goes one step further, identifying that patient activation and the frequency of patient-provider conversations are the "two most powerful" factors in predicting whether patients pursue preventive behaviors to safeguard their kidney health. For example, patients who were highly activated and had frequent conversations with their providers were more likely to engage in daily lifestyle changes, like measuring their salt intake. The study is particularly relevant to the care of older adults, given the mean age of the study population was 58.8 years.

“Given what we know about treatments that can prevent the progression of kidney disease, patients with diabetes and hypertension remain unaware, untested and untreated for CKD for way too long,” said Hilary Hatch, Chief Clinical Officer at Phreesia. “These results have huge implications for how to increase awareness, which in turn would speed up diagnosis and treatment. Phreesia is well-positioned to do this because we can deliver personalized messages to patients at the point of care, prompting conversations with providers and supporting patients to take a more active role in adopting behaviors to manage their kidney health.”

The survey results also reinforce the notion that patients who can independently manage their health generally have better outcomes, finding that patients with higher activation levels are significantly more likely to have discussed kidney health with their provider. Additionally, activated patients with diabetes or hypertension are more aware of the link between their current condition and kidney health.

“This research illustrates that the frequency of patient-provider conversations and patient activation influence patient awareness of their risk for CKD,” said Elizabeth Montgomery, National Vice President of Learning Strategies and Population Health Programs at the National Kidney Foundation and co-author of the research. “Strategies to improve patient initiation of conversations with their clinicians regarding kidney disease risk is one pathway to improve the low rates of CKD testing and diagnosis in the U.S.”

CKD affects an estimated 37 million people in the U.S. Because early stages have no symptoms, it is a silent killer—approximately 90% of those with CKD don't know they have it. This study found that even eight or more years after receiving one of these two high-risk diagnoses, 43% of surveyed patients with diabetes and 78% of surveyed patients with hypertension were still unable to identify their risk for kidney disease.

To bridge this awareness gap, it is critical to encourage patient-provider conversations about kidney health and support activation in patients. There is also growing recognition that educating and engaging patients in their care helps drive preventive behaviors. Using the PAM as a predictor of a patient’s awareness of kidney disease risk and engagement, providers can tailor interventions to each patient based on their activation level. Assessments of patient activation are already in use as a quality measure in some kidney care programs, like the Center for Medicare and Medicaid Innovation Kidney Care Choices (KCC) Model.

For more information on Phreesia, visit

About Phreesia

Phreesia is the trusted leader in patient activation, giving providers, life sciences companies, payers and other organizations tools to help patients take a more active role in their care. Founded in 2005, Phreesia enabled approximately 150 million patient visits in 2023—more than 1 in 10 visits across the U.S.—scale that we believe allows us to make meaningful impact. Offering patient-driven digital solutions for intake, outreach, education and more, Phreesia enhances the patient experience, drives efficiency and improves healthcare outcomes. To learn more, visit


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