Do dialysis patients understand health info?

Many patients on dialysis might not understand medical information critical to their wellbeing, according to a study appearing online for the Clinical Journal of the American Society Nephrology (CJASN).1 The results suggest that clinicians must understand and address the limited health literacy of patients with kidney disease.

Patients with limited health literacy might not fully understand written medical information and might not be able to communicate effectively with healthcare providers or navigate the increasingly complex healthcare system. Studies suggest that limited health literacy might negatively affect patients' wellbeing and increase healthcare costs.

Health literacy is particularly important for kidney patients undergoing dialysis. They must attend treatment sessions several days a week, follow dietary and fluid restrictions, and adhere to complex medication regimens, all of which require patients to understand and act on complicated health-related information. Jamie Green, MD, University of Pittsburgh, and her colleagues tested 260 patients on long-term dialysis with a tool that assesses one's ability to read common medical words and lay terms for body parts and illnesses.

The investigators found that 16% of the patients on dialysis (41 of the 260 patients) had limited health literacy. There are more than 350,000 U.S. patients on dialysis, so this percentage represents a significant number of individuals who could benefit from being better able to understand and manage their kidney health. While limited health literacy was present in all subgroups, those with lower educational levels, African Americans, and veterans were less likely to effectively obtain and process relevant health information.

Patients with less than a high school education exhibited more than a 12-fold increased risk of low health literacy, and African Americans and veterans had more than a threefold increased risk of having limited health literacy. The researchers are following these individuals to determine if limited health literacy affects how patients adhere to dialysis treatment, whether they undergo kidney transplantation, and whether they die prematurely.

"We anticipate our findings will increase awareness of the importance of health literacy in patients with kidney disease, stimulate providers to consider literacy when communicating with patients, and lead to future studies to address limitations in health literacy," said Green.

Study co-authors include Maria Mor, PhD, Mary Ann Sevick, Paul Palevsky, MD, Michael Fine, MD, and Steven Weisbord, MD, at the VA Pittsburgh Healthcare System and University of Pittsburgh; Anne Marie Shields at the VA Pittsburgh Healthcare System; and Robert Arnold, MD, at the University of Pittsburgh.


1. Green JA, Mor MK, Shields AM. Prevalence and demographic and clinical associations of health literacy in patients on maintenance hemodialysis. CJASN 2011; May online. Doi: 10.2215/CJN.09761110.