Health Literacy Not Associated with Chronic Kidney Disease Awareness

Health Lit Res Pract. 2017 Sep 6;1(3):e117-e127. doi: 10.3928/24748307-20170608-01. eCollection 2017 Jul.


Background: 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.

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

Methods: 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.

Key results: 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).

Conclusions: 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.].

Plain language summary: 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.