Hemodialysis Access Choice: Impact of Health Literacy

Abstract

Background: Hemodialysis patients need to make decisions about vascular access and diet that they may not fully understand. In this study, we hypothesized that patients with low health literacy are likely to choose a central venous catheter (CVC) and have higher serum potassium (K), serum phosphate (P), and inter-dialysis weight gains (IDWG). Objective: Primarily, the study sought to describe the health literacy of patients treated with hemodialysis in a Canadian tertiary care center. The secondary objective was to describe the association between health literacy and permanent vascular access choice, hyperkalemia, hyperphosphatemia, and IDWG. Methods: Adult patients receiving hemodialysis for more than 6 months were included. Health literacy was assessed with the Newest Vital Sign (NVS) test. Vascular access type and reasons for CVC use were determined. Serum K, P, and IDWG were collected retrospectively for 6 months. Student's t test and logistic regression were used to determine the association between health literacy (NVS score < 4 versus ≥ 4) and CVC choice, hyperkalemia, hyperphosphatemia, and high IDWG. Key Results: Fifty-six patients were involved. The average NVS score was 2.9. Overall, 66% of the patients had a CVC; one-third had chosen this access themselves. Poor control of K, P, and IDWG was experienced by 27%, 55%, and 36% of patients, respectively. The average NVS score was lower for patients choosing a CVC ( p = .001), but not different for those with higher K, P, or IDWG. None of the patients who chose a CVC had adequate health literacy (NVS ≥ 4). Conclusions: Patients with low health literacy, who are eligible for both surgically created vascular access (fistula or graft) and CVC, are more likely to refuse fistula/graft creation compared to patients with adequate health literacy. Different educational strategies for such patients may help in appropriate decision-making. [ Health Literacy Research and Practice . 2017;1(3):e136–e144.] Plain Language Summary: This study suggests that more than one-half of patients who receive hemodialysis may not understand all the information provided by their health care team. Despite a higher risk of complications with a central venous catheter, patients with lower health literacy prefer the catheter over fistula as their blood access for hemodialysis. We need to explore patient education to ensure that information is easy to understand.

Does Health Literacy of Hemodialyzed Patients Predict the Type of Their Vascular Access? A Cross-Sectional Study on Slovak Hemodialyzed Population

“…We found that patients with greater ability to engage with healthcare providers, those with better ability to navigate the healthcare system, those more able to find good health information, and those who understand it well enough to know what to do are more likely to have AVF as their VA. Cavanaugh et al [23] brought similar findings, whereby dialyzed patients with limited HL were more likely to have CVC. Mazarova et al [12] focused on functional HL in dialyzed patients and their choice of the type of VA, and they found that patients with low HL were more likely to prefer CVC. They concluded that this is due to a lack of education and information for patients from healthcare providers needed for informed decision-making about their VA.…”

“…A well-functioning VA is essential for effective hemodialysis treatment, but the selection of the VA type requires taking into consideration many factors that affect the possible access failure, such as the patient's demographic factors, the patient's adherence to fistula care, and cooperation between healthcare professionals and the patient [2,5]. Several modifiable factors are associated with the selected type of VA, such as the patients' preference [10,11] and health literacy (HL) [12].…”

Buttonhole versus Stepladder Cannulation for Home Hemodialysis

“…We also did not verify that patients were truly making informed choices about the potential risks versus benefits of the two cannulation techniques. Low health literacy has been associated with hemodialysis access choice, but may not apply to patients on home hemodialysis or cannulation technique (31). Alternatively, there may also be health care provider preference for training patients to do buttonhole instead of stepladder cannulation (15).…”

Surface modification strategies for hemodialysis catheters to prevent catheter‐related infections: A review

“…In HD treatment, there are 3 possible options for vascular access: arteriovenous fistula (AVF), arteriovenous graft (AVG) and HD central venous catheter (CVC) 4 (see, Figure 1). Although both AVFs and AVGs are preferred over CVCs as permanent hemodialysis vascular access devices for HD patients, CVCs can still be the initial choice although they cause higher risk of mortality, fatal infection, and cardiovascular events when used permanently 5 . In the United States, about 70 to 80% of patients undergoing HD therapy use CVC initially 6 .…”