• adherence
• emotional management
• health literacy
• quality of life
• renal replacement therapy

• AP-0567-2024-C5-F2 Consejería de Salud y Consumo

• brief health literacy screen
• cancer
• health literacy

• Humans
• Male
• Health Literacy/statistics & numerical data
• Female
• Neoplasms/mortality
• Neoplasms/pathology
• Middle Aged
• Aged
• Retrospective Studies
• Adult
• Proportional Hazards Models
• Cause of Death
• Aged, 80 and over

• chronic kidney disease
• health literacy
• kidney failure
• renal replacement therapy
• shared decision-making

• Chronic kidney disease
• End-stage kidney disease
• Health literacy
• Self-management

• Humans
• Quality of Life
• Health Literacy
• Self-Management
• Renal Insufficiency, Chronic/diagnosis
• Renal Insufficiency, Chronic/therapy
• Outcome Assessment, Health Care

• CVD
• chronic kidney disease
• health literacy
• hospitalization
• mortality

• Humans
• Adult
• Cohort Studies
• Prospective Studies
• Health Literacy
• Renal Insufficiency, Chronic/complications
• Heart Failure/complications
• Peripheral Arterial Disease
• Cardiovascular Diseases/epidemiology
• Cardiovascular Diseases/etiology
• Risk Factors

• UL1 TR000433 NCATS NIH HHS
• U54 MD012523 NIMHD NIH HHS
• U01 DK061021 NIDDK NIH HHS
• U01 DK060990 NIDDK NIH HHS
• M01 RR013987 NCRR NIH HHS
• R01 DK118736 NIDDK NIH HHS
• R01 DK119199 NIDDK NIH HHS
• UL1 TR000003 NCATS NIH HHS
• UL1 TR000439 NCATS NIH HHS
• K01 AG075353 NIA NIH HHS
• U01 DK061022 NIDDK NIH HHS
• U01 DK061028 NIDDK NIH HHS
• UL1 RR029879 NCRR NIH HHS
• U01 DK060902 NIDDK NIH HHS
• K24 DK092290 NIDDK NIH HHS
• R01 DK072231 NIDDK NIH HHS
• U24 DK060990 NIDDK NIH HHS
• U01 DK060980 NIDDK NIH HHS
• UL1 RR024131 NCRR NIH HHS
• U01 DK060984 NIDDK NIH HHS
• R56 DK072231 NIDDK NIH HHS
• UL1 TR000424 NCATS NIH HHS
• M01 RR016500 NCRR NIH HHS
• P20 GM109036 NIGMS NIH HHS
• National Institute of Diabetes and Digestive and Kidney Diseases
• Perelman School of Medicine, University of Pennsylvania
• NIH
• NCATS
• Johns Hopkins University
• University of Maryland
• Clinical and Translational Science Collaborative of Cleveland
• Michigan Institute for Clinical and Health Research
• University of Illinois at Chicago
• Tulane COBRE for Clinical and Translational Research in Cardiometabolic Diseases
• NCRR
• Department of Internal Medicine, University of New Mexico School of Medicine Albuquerque
• NIA
• NHBLI
• NIMHD
• Center For Health Equity Research
• NIDDK

• animation
• community-based participatory research
• digital media
• health education
• kidney transplant access

• Adult
• Humans
• Kidney Transplantation
• Feasibility Studies
• Communication
• Kidney
• Referral and Consultation

• UL1 TR001412 NCATS NIH HHS

• cardiovascular disease
• disease prevention
• geriatric population
• health literacy
• metabolic risk factors

• JSPS KAKENHI

Self-care behavior plays a pivotal role in the management of chronic kidney disease. Improved self-care behavior in patients with chronic kidney disease is a key factor in health management and treatment adherence. This study aimed to evaluate the participants’ general and medical condition-related characteristics, physiological indices and the level of health literacy affecting self-care behavior in patients with chronic kidney disease in South Korea. The data of 278 participants were analyzed using t-test, analysis of variance, correlation coefficient, and linear multiple regression analysis. There were significant differences in self-care behavior scores depending on participants’ age and cohabitation status, employment, and smoking status as well as having dialysis due to end-stage kidney disease; number of comorbidities; levels of serum hemoglobin, calcium, and creatinine; and estimated glomerular filtration rate. The results of regression analysis revealed that not currently working, non-smoker, end-stage kidney disease, and positive response to the “actively managing my health” scale of the Health Literacy Questionnaire significantly affected self-care behavior in patients with chronic kidney disease, and the explanatory power of the model was 32.7%. Therefore, it is necessary to identify each patient’s barriers or needs according to individual characteristics, such as age, cohabitation and employment status, and daily life circumstances, including smoking habits, comorbidities, social support, and level of health literacy to develop efficient support strategies for promoting adequate self-care behavior with CKD.

• Calcium
• Creatinine
• Dialysis
• Humans
• Kidney Failure, Chronic/complications
• Kidney Failure, Chronic/therapy
• Renal Insufficiency, Chronic/complications
• Renal Insufficiency, Chronic/therapy
• Self Care

• K23 DK123313 NIDDK NIH HHS

• Comprehension
• Cross-sectional studies
• Literacy
• Social security
• Socio-economic background

• Disabled Persons
• Female
• Health Literacy
• Humans
• Income
• Social Security
• Socioeconomic Factors
• Surveys and Questionnaires

• Institute for Employee Benefits Schemes (UWV)

• Chronic kidney disease
• Disease burden
• Frequent contact with the healthcare system
• Health literacy
• Presence of acquaintance

• COVID-19
• SARS-CoV-2
• anxiety
• chronic kidney disease
• chronic renal disease
• disparity
• epidemiology and outcomes

• Aged
• Anxiety/epidemiology
• COVID-19/epidemiology
• Cardiovascular Diseases/complications
• Female
• Humans
• Male
• Pandemics
• Renal Insufficiency, Chronic/epidemiology
• Weight Gain

• U24 DK060990 NIDDK NIH HHS
• UL1 RR024131 NCRR NIH HHS
• R01 DK119199 NIDDK NIH HHS
• UL1 TR000003 NCATS NIH HHS
• UL1 TR000439 NCATS NIH HHS
• UL1 RR029879 NCRR NIH HHS
• U01 DK061028 NIDDK NIH HHS
• UL1 TR000433 NCATS NIH HHS
• UL1 TR000424 NCATS NIH HHS
• M01 RR016500 NCRR NIH HHS
• P20 GM109036 NIGMS NIH HHS
• U01 DK060902 NIDDK NIH HHS
• National Institute of Diabetes and Digestive and Kidney Diseases
• NIH/National Center for Advancing Translational Sciences (NCATS)
• Johns Hopkins University
• Clinical and Translational Science Collaborative of Cleveland
• Michigan Institute for Clinical and Health Research

• Chronic kidney disease
• dialysis preparation
• patient education
• patient empowerment
• patient-centered outcomes
• transplantation education

• K24 HL148181 NHLBI NIH HHS
• T32 DK007732 NIDDK NIH HHS

Limited health literacy (LHL) is common in chronic kidney disease (CKD) patients and frequently associated with worse self-management. Multi-component interventions targeted at patients and healthcare professionals (HCPs) are recommended, but evidence is limited. Therefore, this study aims to determine the objectives and strategies of such an intervention, and to develop, produce and evaluate it. For this purpose, we included CKD patients with LHL (n = 19), HCPs (n = 15), educators (n = 3) and students (n = 4) from general practices, nephrology clinics and universities in an Intervention Mapping (IM) process. The determined intervention objectives especially address the patients’ competences in maintaining self-management in the long term, and communication competences of patients and HCPs. Patients preferred visual strategies and strategies supporting discussion of needs and barriers during consultations to written and digital strategies. Moreover, they preferred an individual approach to group meetings. We produced a four-component intervention, consisting of a visually attractive website and topic-based brochures, consultation cards for patients, and training on LHL for HCPs. Evaluation revealed that the intervention was useful, comprehensible and fitting for patients’ needs. Healthcare organizations need to use visual strategies more in patient education, be careful with digitalization and group meetings, and train HCPs to improve care for patients with LHL. Large-scale research on the effectiveness of similar HL interventions is needed.

• chronic kidney disease
• communication
• health literacy
• intervention
• patient education
• professional training
• self-management

• Health Literacy
• Health Personnel/education
• Humans
• Renal Insufficiency, Chronic/therapy
• Self-Management
• Students

Low health literacy in the chronic kidney disease population results in lower rates of pre-dialysis preparation and understanding of management to slow progression. The ABCs of Kidney Disease education class provided education in a more consistent manner outside of routine office visits. We aimed to study whether a structured education program would increase kidney disease-specific knowledge and healthcare involvement. Knowledge retention at least 6 months after the class assessed by the Kidney Disease Knowledge Surveys (KiKS) and healthcare involvement based on surveys sent to referring providers were found to have increased. Incorporation of a structured education program would be important for providers to improve long-term knowledge and lead to greater healthcare involvement. Providing an education class outside of the routine office visits will provide a greater impact on health literacy.

• clinician–patient relationship
• patient education
• patient engagement
• patient feedback

• chronic kidney disease
• health literacy
• knowledge
• self-care
• self-management

• Adult
• Health Literacy
• Humans
• Renal Insufficiency, Chronic/therapy
• Self-Management

Despite the growing burden of chronic kidney disease (CKD), disease knowledge and understanding are still lacking, especially in Bangladesh.

The aim of this study was to evaluate the outcome of a health education intervention in order to enhance knowledge, health-related quality of life (QOL), and motivation regarding healthy lifestyles among rural and periurban adults suffering from CKD.

A parallel-group (1:1) randomized controlled trial is ongoing in the Mirzapur subdistrict, Bangladesh, where two groups of patients with CKD are being compared. Patients aged 18 years and over with CKD (stages 1-3) were enrolled in November 2020. Patients were randomly allocated into either the intervention group (n=63) or the control group (n=63). The control group received usual treatment, while the intervention group received health education through a CKD campaign facilitated by a nephrologist and via mHealth (ie, periodic mobile phone calls) from community health workers. Both groups were followed up for a period of 6 months. The primary endpoint is patients’ increased knowledge measured using the Chronic Kidney Disease Knowledge Questionnaire. The secondary endpoints are improved QOL measured using the standardized EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire as well as improvements in the levels of blood pressure, BMI, serum creatinine, fasting blood sugar, hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen, and albumin to creatinine ratio.

Enrollment of participants began in November 2020; the intervention and follow-up were completed in May 2021. We enrolled 126 patients in the study. Patients’ mean ages were 57.97 (SD 15.03) years in the control group and 57.32 (SD 14.37) years in the intervention group. There were 45 out of 63 (71%) females in the control group and 38 out of 63 (60%) females in the intervention group. In addition, there were 38 out of 63 (60%) literate patients in the control group and 33 out of 63 (52%) literate patients in the intervention group.

It is expected that a combined approach, incorporating both a CKD campaign and mHealth, for health education may be an effective tool for increasing knowledge and improving QOL among patients with CKD.

ClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831

DERR1-10.2196/30191

• Bangladesh
• campaign
• chronic kidney disease
• knowledge
• mHealth

• animation
• arteriovenous
• catheter
• dialysis
• education
• fistula
• graft
• hemodialysis
• mixed methods
• stakeholder
• vascular access
• video

• Focus Groups
• Health Personnel
• Humans
• Pamphlets
• Renal Dialysis

• K23 DK109401 NIDDK NIH HHS
• R21 DK116115 NIDDK NIH HHS
• NIDDK

Health literacy refers to the ability of individuals to gain access to, use, and understand health information and services in order to maintain a good health. It is especially important in nephrology due to the complexity of chronic kidney disease (CKD). The present study sought to define health literacy levels in patients followed in predialysis clinic, in-center dialysis (ICHD), peritoneal dialysis (PD) and home hemodialysis (HHD).

This transversal monocentric observational study analysed 363 patients between October 2016 and April 2017. The Brief Health Literacy Screen (BHLS) and the Health Literacy Questionnaire (HLQ) were used to measure health literacy. Multivariate linear regressions were used to compare the mean scores on the BHLS and HLQ, across the four groups.

Patients on PD had a significantly higher BHLS’score than patients on ICHD (p = 0.04). HLQ’s scores differed across the groups: patients on HHD (p = 0.01) and PD (p = 0.002) were more likely to feel understood by their healthcare providers. Compared to ICHD, patients on HHD were more likely to have sufficient information to manage their health (p = 0.02), and patients in the predialysis clinic were more likely to report high abilities for health information appraisal (p < 0.001).

In a monocentric study, there is a significant proportion of CKD patients, especially in predialysis clinic and in-centre hemodialysis, with limited health literacy. Patients on home dialysis (HHD and PD) had a higher level of health literacy compared to the other groups.

The online version contains supplementary material available at 10.1186/s12882-021-02464-1.

• Chronic kidney disease
• Health literacy
• Hemodialysis
• Peritoneal dialysis

• BMI
• chronic kidney disease
• cohort
• health literacy
• prevention

• Adult
• Age of Onset
• Aged
• Body Mass Index
• Female
• Follow-Up Studies
• Glomerular Filtration Rate
• Health Literacy/statistics & numerical data
• Humans
• Male
• Middle Aged
• Netherlands/epidemiology
• Prospective Studies
• Renal Insufficiency, Chronic/classification
• Renal Insufficiency, Chronic/epidemiology
• Renal Insufficiency, Chronic/physiopathology
• Risk Factors

Chronic kidney disease (CKD) is a global public health issue that is associated with high rates of morbidity and mortality. Self-care behavior has been associated with clinical outcomes in chronic diseases, and adequate self-care behavior may mitigate adverse outcomes. Health literacy may be an important factor associated with self-care. The aim of this study was to examine the relationships between different domains of self-care behavior and health literacy in patients with CKD. This study enrolled 208 patients with CKD stages 1–5 who were not undergoing renal replacement therapy at Kaohsiung Medical University Hospital from April 2019 to January 2020. Health literacy was measured using a multidimensional health literacy questionnaire covering the following five dimensions: accessing, understanding, appraising, and applying health information, and communication/interaction. The CKD Self-Care scale, which is a 16-item questionnaire with five domains including medication adherence, diet control, exercise, smoking behavior, and home blood pressure monitoring was used to assess self-care behavior. Among the 208 patients, 97 had sufficient or excellent health literacy, and 111 had inadequate or limited/problematic health literacy. A higher health literacy score was significantly correlated with greater self-care behavior. Among the five domains of self-care behavior, the patients who had sufficient or excellent health literacy had higher diet, exercise, and home blood pressure monitoring scores than those who had inadequate or limited/problematic health literacy. This study demonstrated that health literacy was significantly and positively correlated with self-care behavior in patients with CKD.

• chronic kidney disease
• health literacy
• self-care behavior

Health literacy is the ability to deal with information related to one’s health. Patients with low health literacy and chronic diseases, such as chronic kidney disease (CKD), have poor disease-management skills, which could lead to complications. We used logistic regressions and structural equational modeling to assess whether low health literacy is associated with the development of cardiovascular disease and mortality in patients with CKD, and whether this association is mediated by the presence of uncontrolled hypertension, diabetes, dyslipidemia, obesity, or albuminuria. Data from 2742 adult participants with CKD from the Lifelines study were analyzed at baseline and after approximately four years. Low health literacy was associated with cardiovascular disease and mortality in the crude models, with OR and 95%CI of 1.93 (1.46 to 2.55) and 1.59 (1.08 to 2.36), respectively. After adjustment for age and sex, low health literacy was only associated with cardiovascular disease (OR 1.76 (1.31 to 2.23)). This association was mediated by uncontrolled diabetes (27.1%) and obesity (8.0%). Low health literacy is associated with the development of cardiovascular disease after adjustment for age and sex, and this association is mediated by uncontrolled diabetes and obesity.

• cardiovascular disease
• chronic kidney insufficiency
• diabetes mellitus
• health literacy
• mortality
• obesity

• Adult
• Cross-Sectional Studies
• Diabetes Mellitus/epidemiology
• Dyslipidemias/epidemiology
• Health Literacy
• Humans
• Hypertension/epidemiology
• Obesity/complications
• Obesity/epidemiology
• Renal Insufficiency, Chronic/epidemiology
• Risk Factors

• chronic kidney disease
• health literacy
• intervention
• systematic review

• Dutch Kidney Foundation
• Behavioural and Social Research Call

• chronic kidney disease
• empowerment
• health-literacy
• integrated care
• patient-centered
• self-management
• self-regulation

• Data Collection
• Humans
• Patient-Centered Care
• Qualitative Research
• Renal Insufficiency, Chronic/epidemiology
• Renal Insufficiency, Chronic/therapy
• Self-Management

Patients with chronic kidney disease make day-to-day decisions about how to self-manage their disease. Chronic kidney disease (CKD) includes a risk for progression towards end-stage renal disease and the development of comorbidities, such as cardiovascular disease, which represents the leading cause of death among these patients. To reduce these risks, CKD patients are recommended to follow a healthy lifestyle with physical activity, food and fluid restrictions, and adherence to complex medication regimes throughout all phases of the disease. To manage the complexity of this health situation, health literacy (HL) is considered essential. The current prevailing understanding is that HL is a multidimensional concept and comprises a range of cognitive, affective, social, and personal skills that determine the motivation and ability to gain access to, understand, and use health information. Recently, we investigated multiple aspects of HL in CKD patients in a quantitative cross-sectional study utilizing the Health Literacy Questionnaire (HLQ) and observed that finding good health information and appraising health information were the most challenging aspects of HL. This study aimed to explore CKD patients’ lived experiences of different dimensions of HL presented in the HLQ.

This qualitative study utilized in-depth semistructured interviews. Twelve patients with different levels of HL were included. The interviews were analyzed using thematic analysis as described by Braun and Clarke.

We identified three main themes that were significant for CKD patients’ HL: 1. Variation in people’s attitudes and behavior as health information seekers, 2. The problem of fragmented healthcare in the context of multimorbidity makes the healthcare system challenging to navigate, and 3. The value of a good relationship with healthcare providers.

CKD patients take different approaches to health information. Limiting or avoiding health information may be a strategy used by some individuals to cope with the disease and does not necessarily mean that health information is inaccessible or difficult to understand. Comorbidity and a fragmented healthcare system can make the healthcare system challenging to navigate. A good and trusting relationship with healthcare providers seems to promote several aspects of HL and should be promoted to optimize CKD patients’ HL.

• Chronic kidney disease
• Health literacy
• Patients’ experiences
• Qualitative study

• BLOOD PRESSURE
• CANCER
• CHRONIC DI
• Cardiovascular disease
• Clinical epidemiology
• EPIDEMIOLOGY
• Epidemiology of chronic non-communicable diseases
• Health inequalities
• LONGITUDINAL STUDIES
• RENAL
• SOCIOECONOMIC

• health literacy
• kidney disease knowledge
• perceived kidney disease knowledge
• self-care
• self-efficacy
• self-management

• K23 DK097183 NIDDK NIH HHS
• K23 DK080952 NIDDK NIH HHS
• R01 DK115844 NIDDK NIH HHS
• L30 DK110819 NIDDK NIH HHS
• F32 DK113681 NIDDK NIH HHS
• R01 DK103935 NIDDK NIH HHS
• K23 DK118198 NIDDK NIH HHS
• K23 DK114526 NIDDK NIH HHS

Web-based portals enable patients to access their electronic health records, including test results and clinical documents, from anywhere with Internet access. Some portals also serve as a means of two-way communication between patients and healthcare professionals and provide a platform for the recording of patient-entered data such as home blood pressure readings. Such systems are designed to encourage patient participation in the management of their condition, and ultimately to increase patient empowerment and self-management, which are associated with improved clinical outcomes. As an example of portal use in patients with renal conditions, we discuss the PatientView portal, which is offered free of cost to patients under the care of renal physicians in the UK. We present an account of its various features and briefly describe the user experience. Previous studies examining the impact of this portal on patient care have been very positive; it appears to be popular among users and overall levels of satisfaction with the service are high. As the use of patient portals increases, we discuss barriers to the more widespread use of portals. We offer suggestions on how the care of patients with renal conditions can be enhanced in the future by further developing the existing features, learning from experiences of other patient portals and providing better integration of portal use into the current model of care.

• PatientView
• chronic renal insufficiency
• information technology
• quality of life
• self-management

• chronic kidney disease
• clinical variables
• demographic variables
• health literacy
• healthcare providers including nurses

• African American
• Chronic kidney disease (CKD)
• disparities
• ethnicity
• health behaviors
• health beliefs
• population health
• race
• review
• risk factor
• social determinants
• socioeconomic status (SES)

• Black or African American
• Health Services Accessibility
• Humans
• Population Surveillance/methods
• Renal Insufficiency, Chronic/ethnology
• Socioeconomic Factors
• United States/epidemiology

• K23 DK103972 NIDDK NIH HHS
• T32 DK104687 NIDDK NIH HHS
• R13 DK072880 NIDDK NIH HHS
• R13 DK098961 NIDDK NIH HHS
• R01 DK067563 NIDDK NIH HHS
• P30 AG021684 NIA NIH HHS
• UL1 TR001881 NCATS NIH HHS
• R25 DK113659 NIDDK NIH HHS
• U54 GM119024 NIGMS NIH HHS

• CKD progression: cardiovascular outcomes
• Chronic renal failure
• all-cause death
• atherosclerotic events
• blood pressure control
• chronic kidney disease (CKD)
• diabetes
• healthy behaviors
• heart failure
• modifiable risk factors
• patient engagement
• self-care
• self-management
• smoking

• Adult
• Aged
• Cohort Studies
• Female
• Humans
• Male
• Middle Aged
• Phenotype
• Prospective Studies
• Renal Insufficiency, Chronic/diagnosis
• Renal Insufficiency, Chronic/therapy
• Self-Management/methods
• Self-Management/trends
• Treatment Outcome
• Young Adult

• R01 DK072231 NIDDK NIH HHS
• UL1 TR002548 NCATS NIH HHS
• F32 DK113681 NIDDK NIH HHS
• UL1 RR024131 NCRR NIH HHS
• U54 GM104940 NIGMS NIH HHS
• U01 DK061022 NIDDK NIH HHS
• UL1 TR000439 NCATS NIH HHS
• U01 DK060990 NIDDK NIH HHS
• UL1 TR002240 NCATS NIH HHS
• K23 DK094829 NIDDK NIH HHS
• UL1 RR029879 NCRR NIH HHS
• U01 DK061028 NIDDK NIH HHS
• UL1 TR000433 NCATS NIH HHS
• U01 DK060984 NIDDK NIH HHS
• U01 DK061021 NIDDK NIH HHS
• U24 DK060990 NIDDK NIH HHS
• U01 DK060980 NIDDK NIH HHS
• T32 DK007785 NIDDK NIH HHS
• U01 DK060963 NIDDK NIH HHS
• UL1 TR000424 NCATS NIH HHS
• M01 RR016500 NCRR NIH HHS
• P20 GM109036 NIGMS NIH HHS
• U01 DK060902 NIDDK NIH HHS
• UL1 TR002003 NCATS NIH HHS

To determine the relationship between chronic kidney disease (CKD) awareness (CKD-A), self-management behaviors (CKD-SMB) knowledge, performance of CKD-SMBs, health literacy (HL) and kidney function.

Participants were eligible patients attending an outpatient nephrology clinic. Participants were administered: Newest Vital Sign to measure HL, CKD self-management knowledge tool (CKD-SMKT) to assess knowledge, past performance of CKD-SMB, CKD-A. Estimated GFR (eGFR) was determined using the MDRD-4 equation. Duration of clinic participation and CKD cause were extracted from medical charts.

One-hundred-fifty patients participated in the study. eGFRs ranged from 17-152 mL/min per 1.73 m². Majority (83%) of respondents had stage 3 or 4 CKD, low HL (63%), and were CKD aware (88%). Approximately 40% (10/25) of patients in stages 1 and 2 and 6.4% (8/125) in stages 3 and 4 were unaware of their CKD. CKD-A differed with stage (P < 0.001) but not by HL level, duration of clinic participation, or CKD cause. Majority of respondents (≥ 90%) correctly answered one or more CKD-SMKT items. Knowledge of one behavior, “controlling blood pressure” differed significantly by CKD-A. CKD-A was associated with past performance of two CKD-SMBs, “controlling blood pressure” (P = 0.02), and “keeping healthy body weight” (P = 0.01). Adjusted multivariate analyses between CKD-A and: (1) HL; and (2) CKD-SMB knowledge were non-significant. However, there was a significant relationship between CKD-A and kidney function after controlling for demographics, HL, and CKD-SMB (P < 0.05).

CKD-A is not associated with HL, or better CKD-SMBs. CKD-A is significantly associated with kidney function and substantially lower eGFR, suggesting the need for focused patient education in CKD stages 1.

• Chronic kidney disease awareness
• Health literacy
• Kidney function
• Self-management behaviors
• Self-management behavior performance
• Epidermal growth factor receptor
• Chronic kidney disease knowledge

Patient awareness of their chronic kidney disease (CKD) and health literacy (HL) are both important for adherence to therapies that slow CKD progression and to reduce risk of complications. Little is known about the association between HL and CKD awareness.

We sought to determine if patient HL is associated with CKD awareness.

We conducted a cross-sectional study of general medicine inpatients at an urban academic medical center discharged between June 2011 and July 2013 with CKD, defined as having at least one CKD International Classification of Diseases, ninth revision code (585.0–585.9), among their first 20 admission diagnoses. Logistic regression was used to analyze the influence of HL, demographic, clinical, and health care use covariates on the likelihood of patients' CKD awareness. Our primary outcome was patient awareness of their CKD, defined as correct patient self-report of “kidney problems.” We used the Brief Health Literacy Screen, a three-item verbal questionnaire, to assess HL.

Among 1,308 patients with CKD, awareness of CKD was 33%, and 48% had adequate HL. However, CKD awareness was not associated with HL even among patients with stage 4 or 5 CKD. In multivariable logistic regression, greater awareness was associated with being a woman, younger than age 50 years, married, White, having hypertension, and having a higher CKD stage (all p < .05). In stratified analyses, patients with hypertension had greater CKD awareness, regardless of HL or diabetes status (p < .05).

Among hospitalized patients with CKD, both CKD awareness and HL are low and inadequate. Surprisingly, patients' knowledge of their CKD diagnosis was not related to patients' HL. Patients with hypertension who young, white, or married may be receiving or retaining more education related to CKD. More work is needed on how to effectively communicate CKD diagnosis to prevent widening health disparities. [Health Literacy Research and Practice. 2017;1(3):e117–e127.]

We studied whether patients with low health literacy also had low awareness of their chronic kidney disease (CKD). Hospitalized patients with CKD were asked three questions about their health literacy and whether they had “kidney problems.” Overall CKD awareness and health literacy were low, but a low score on one did not predict a low score on the other.

• K23 DK103111 NIDDK NIH HHS

• Cohort Studies
• Cross-Sectional Studies
• Disease Management
• Ethnic Groups
• Health Literacy
• Humans
• Patient Selection
• Prevalence
• Renal Insufficiency, Chronic
• Self Care
• Social Class
• Surveys and Questionnaires
• chronic kidney disease
• ethnicity
• renal dialysis
• transplantation

• Female
• Health Knowledge, Attitudes, Practice
• Health Literacy
• Humans
• Kidney Transplantation
• Male
• Middle Aged
• Prognosis
• Renal Dialysis
• Renal Insufficiency, Chronic/diagnosis
• Renal Insufficiency, Chronic/ethnology
• Renal Insufficiency, Chronic/psychology
• Renal Insufficiency, Chronic/therapy
• Risk Factors
• Self Care
• Social Class

• RP-PG-0109-10116 Department of Health

• Access to health care
• Health services
• Kidney disease
• Patient education as topic
• Telemedicine

• chronic kidney disease
• end stage kidney disease
• psychosocial factors
• racial disparities
• social determinants
• socioeconomic status

• Health Services Accessibility
• Health Status Disparities
• Humans
• Models, Theoretical
• Racial Groups
• Renal Insufficiency, Chronic/epidemiology
• Renal Insufficiency, Chronic/ethnology
• Social Determinants of Health
• Socioeconomic Factors

Health literacy is the capacity of an individual to understand information related to a disease in order to make an informed decision. In patients with kidney diseases, studies have reported increasing impact of limited health literacy on health outcomes. Our paper discusses current literature on health literacy in kidney diseases.

• Health literacy
• Kidney diseases
• Rapid estimate of adult literacy in medicine
• Hemodialysis
• Peritoneal dialysis
• Chronic kidney disease

• CKD
• clinical outcome
• eGFR
• health literacy
• kidney function

• Anticholesteremic Agents/therapeutic use
• Educational Status
• Ezetimibe/therapeutic use
• Female
• Humans
• Male
• Renal Insufficiency, Chronic/prevention & control
• Simvastatin/therapeutic use

• K23 DK097183 NIDDK NIH HHS
• R01 DK103935 NIDDK NIH HHS

Health literacy (HL) has gained increasing attention in public health research. However, until now research was mainly focused on clinical settings rather than on the general population. Due its relation to social determinants and health outcomes, HL is of special interest in epidemiological studies. The aim of the present study was therefore to describe HL among an elderly general high-risk population, to analyze the potential contributing factors of HL, and to analyze the impact of HL on health-related outcomes.

We used data from the CARLA Study, which is a prospective population-based cohort study of the elderly general population of the city of Halle (Saale) in Eastern Germany. The short version of the HLS-EU Questionnaire (HLS-EU-Q16) was administered with 1,107 subjects aged between 55 and 91 year old. A HL score ranging from 0 to 50 points was computed and classified according to the recommendation of the HLS-EU project. Socio-economic as well as health-related variables were determined during the standardized interview and clinical examination. We calculated linear as well as logistic regression models in order to analyze the association between HL and health-related outcomes as well as potential influencing factors of HL.

Overall, the HL score was 36.9 (SD 6.9). Among all subjects, 4 % showed inadequate HL, 23 % problematic HL, 50 % sufficient HL, and 23 % excellent HL. HL was positively associated with educational level, net household income, and self-perceived social position. Further, we found an increase of HL with age (β = 0.10; 95 % CL 0.05; 0.15) and a lower HL score among women compared with men (Diff = -1.4; 95 % CL −2.2; −0.6). An inverse association was observed between HL and diabetes among both sexes (OR 0.93; 95 % CL 0.93; 0.98), between HL and myocardial infarction among women, and between HL and stroke among men.

In this elderly general Eastern German population, we found higher HL score values compared with previous studies using the same questionnaire. HL was associated with socio-economic status. Furthermore, this cross-sectional study could show associations between HL and different health-related outcomes even after adjustment for educational level. However, further research is needed in order to evaluate the impact of HL on health-related outcomes using longitudinal data derived from the general population.