Health Literacy and Access to Kidney Transplantation

Abstract

Background and objectives: Few studies have examined health literacy in patients with end stage kidney disease. We hypothesized that inadequate health literacy in a hemodialysis population is common and is associated with poorer access to kidney transplant wait-lists.Design, setting, participants, & measurements: We enrolled 62 Black and White maintenance hemodialysis patients aged 18 to 75. We measured health literacy using the short form Test of Functional Health Literacy in Adults. Our primary outcomes were (1) time from dialysis start date to referral date for kidney transplant evaluation and (2) time from referral date to date placed on kidney transplant wait-list. We used Cox proportional hazard models to examine the association between health literacy (adequate versus inadequate) and our outcomes after controlling for demographics and co-morbid conditions.Results Conclusions: Inadequate health literacy is common in our hemodialysis patient population and is associated with a lower hazard of referral for transplant evaluation. Strategies to reduce the impact of health literacy on the kidney transplant process should be explored.

Impact of a Patient Education Program on Disparities in Kidney Transplant Evaluation

“…This finding may also explain why evaluation completion increased for all patients, regardless of race or SES level. Health literacy is also associated with access to transplant (20), and the emphasis on interactive patient education may be one reason why patients with lower SES saw an improvement in evaluation completion after the intervention at our center. An additional explanation may be that the formal education session indirectly improved evaluation completion.…”

Prevalence and Demographic and Clinical Associations of Health Literacy in Patients on Maintenance Hemodialysis

“…Health literacy may be particularly germane to the care and outcome of patients with ESRD receiving hemodialysis, because this patient population must attend regular dialysis treatments to maintain electrolyte and fluid balance; follow dietary restrictions related to fluid, sodium, phosphorous, and potassium intake; and adhere to multiple medications to treat or prevent the complications of ESRD. Preliminary studies suggest that limited health literacy is prevalent in patients receiving chronic hemodialysis and may be associated with adverse outcomes including mortality (25,26). However, these studies either enrolled small numbers of patients or restricted their study populations to those suspected of having low health literacy.…”

Must Health Literacy Be a Prerequisite for Kidney Transplantation?

“…Ayanian et al (6) found that fewer than 40% of patients who began dialysis were aware of transplantation as an option, but after education regarding treatment modalities, the patients they studied in Alabama, southern California, Michigan, and the mid-Atlantic area expressed sentiments remarkably similar to the Bay Area patients in the article by Grubbs et al (1): 80% wanted transplants. It must also be pointed out that both studies, by design, excluded the 50% or so of kidney transplant recipients who had successfully navigated the "system" enabling transplantation either preemptively or within the first year of RRT (7).…”

“…Perhaps the patients studied by Grubbs et al (1) do not represent most dialysis patients. Ayanian et al (6) found that fewer than 40% of patients who began dialysis were aware of transplantation as an option, but after education regarding treatment modalities, the patients they studied in Alabama, southern California, Michigan, and the mid-Atlantic area expressed sentiments remarkably similar to the Bay Area patients in the article by Grubbs et al (1): 80% wanted transplants.…”

“…A study of the impact of health literacy on access of dialysis patients to transplantation in this issue of CJASN found 90% favoring transplantation as their preferred modality of therapy (1). Regardless of original kidney disease, age, gender, ethnicity, educational status, income level, dialysis provider, or health literacy, from a patient's perspective, transplantation is the best option.…”