Comparison of health literacy profile of patients with end stage kidney disease on dialysis versus non-dialysis chronic kidney disease and the influencing factors: a cross-sectional study

Objectives: Lower health literacy (HL) is associated with poor outcomes in
patients with kidney disease. Since HL matches the patient’s competencies
with the complexities of the care package, the level of HL sufficient in
earlier stages of chronic kidney disease (CKD) may be inadequate for
end-stage kidney disease (ESKD) patients on dialysis. We aimed to analyse
the HL profile of ESKD and non-dialysis CKD patients and examine if there
were significant associations with covariates which could be targeted to
address HL deficits, thereby improving patient outcomes. Design and
setting: Cross-sectional study of CKD and ESKD patients from a single
Australian health district. Methods: We assessed the HL profile of 114 CKD
and 109 ESKD patients using a 44-item multi-domain HL Questionnaire (HLQ)
and examined its association with demographic factors (age, gender, race),
smoking, income, education, comorbidities, carer status, cognitive
function and depression. Using multi-variable logistic regression models,
HL profiles of CKD and ESKD patients were evaluated after adjusting for
covariates. Results: Patients with ESKD had similar demographics and
educational levels compared to CKD patients. ESKD had significantly higher
frequency of vascular disease, cognitive impairment and depression. ESKD
patients had better HL scores for the social support domain (37.1% vs
19.5% in higher HLQ4 tertile, p=0.004), whereas all other HL domains
including engagement with healthcare providers were comparable to CKD.
Depression was independently associated with nearly all of the HL domains
(HLQ1: OR 2.6, p=0.030, HLQ2: OR 7.9, p=<0.001, HLQ3: OR 7.6,
p<0.001, HLQ4: OR 3.5, p=0.010, HLQ5: OR 8.9, p=0.001, HLQ6: OR
3.9, p=0.002, HLQ7: OR 4.8, p=0.001, HLQ8: OR 5.3, p=0.001) and education
with HL domains relevant to processing health related information (HLQ8:
OR 2.6, p=0.008, HLQ9: OR 2.5, p=0.006). Conclusions: Despite very
frequent interactions with health systems, ESKD patients on dialysis did
not have higher HL in engagement with health providers and most other HL
domains, compared to CKD patients. Strategies promoting patient-provider
engagement and managing depression which strongly associates with lower HL
may address the impact of HL deficits and favourably modify clinical
outcomes in renal patients.