The Relationship Between Health Literacy and Outcomes Before and After Kidney Transplantation

Abstract

Background. Limited health literacy (HL) is associated with decreased kidney function and death in patients with chronic kidney disease. Less is known about the impact of HL on kidney transplant (KT) outcomes. The aim of this study was to examine the relationship between HL and KT outcomes, including rates of waitlisting, healthcare utilization, acute rejection, renal allograft function, renal allograft failure, and death. Methods. We performed a retrospective review of HL data previously collected at our center. HL was assessed in a convenience sample of consecutive, English-speaking patients age ≥18 y who were evaluated for KT at Mayo Clinic in Minnesota between June 2015 and March 2017 as part of a practice improvement feasibility project (n = 690). HL was assessed using the 4-item Brief Health Literacy Screening Tool modified for the outpatient KT evaluation process. The 4 items assess confidence completing forms, reading comprehension, and oral literacy. Results. Overall, 30.4% of patients had limited or marginal HL. Patients with limited or marginal HL were less likely than those with adequate HL to be waitlisted for KT (hazard ratio = 0.62 and 0.69, respectively), even after adjusting for age, marital status, body mass index, Charlson comorbidity index, or dialysis dependency. Patient HL was not associated with post-KT healthcare utilization, acute rejection, or renal allograft function. Patients with limited or marginal HL appeared to experience a higher risk of renal allograft failure and post-KT death, but the number of events was small, and the relationship was statistically significant only for marginal HL. Conclusions. Inadequate HL is common in KT candidates and independently associated with decreased waitlisting for KT. We observed no statistically significant relationship between HL and posttransplant outcomes in our cohort. Further efforts to improve communication in patients with inadequate HL may improve access to KT.

Preliminary Evaluation of 2 Patient-Centered Educational Animations About Kidney Transplant Complications

“…Prior research has shown that patient knowledge, or health literacy, is associated with transplant access [ 18 – 20 ] and outcomes [ 20 , 21 ]. However, the extent to which previous educational approaches explained transplant risks is unknown.…”

Is Non-Adherence Associated with Adverse Outcomes in Kidney Transplant Recipients? The Role of Non-Adherence as a Risk and Predictor Factor for Graft Loss and Death

“…Health literacy has been studied in kidney recipients before and after the transplant, with evidence that marginal health literacy increases waiting list mortality and decreases patient survival following kidney transplantation. 14 Some authors consider that the relation of non-adherence with graft loss is caused by an increased cellular rejection and less benefits from immunosuppressors. 15 Therefore, even if adherence has been defined as the complete patient behavior regarding the treatment and disease, most evidence in kidney transplant reported the outcomes of a fragment of adherence, commonly INA or ANA.…”