Telling the truth: why disclosure matters in chronic kidney disease

![][1] The dynamics of the doctor–patient relationship have evolved over recent decades from a model of benevolent paternalism to a framework centred around shared decision making,1 for which patient awareness of their diagnoses, and hence disclosure of diagnoses by healthcare professionals, are prerequisites. Some of the complexities and challenges inherent in this paradigm shift are illustrated by the example of chronic kidney disease (CKD), a condition of internationally high prevalence and low awareness.2 In the UK chronic disease management in primary care is incentivised through the Quality and Outcomes Framework (QOF). CKD has been included within the QOF since 2006, but is under-diagnosed in primary care. While CKD stage 3 to 5 prevalence rates are estimated at 6% of the adult population,3 only 4.3% of the population are on CKD registers.4 Furthermore, the majority of the QOF-registered population may be unaware of their diagnosis; data from the Health Survey for England indicate that only 1.5% of males and 1.3% of females had been informed by their doctors that they have kidney disease.3 The reasons underlying low ascertainment and non-disclosure in CKD are likely to be complex … [1]: /embed/graphic-1.gif