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Limited health literacy is associated with reduced access to kidney transplantation

Lookup NU author(s): Dr Charlie Tomson


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© 2019 International Society of Nephrology Limited health literacy is common in patients with chronic kidney disease (CKD) and has been variably associated with adverse clinical outcomes. The prevalence of limited health literacy is lower in kidney transplant recipients than in individuals starting dialysis, suggesting selection of patients with higher health literacy for transplantation. We investigated the relationship between limited health literacy and clinical outcomes, including access to kidney transplantation, in a prospective UK cohort study of 2,274 incident dialysis patients aged 18-75 years. Limited health literacy was defined by a validated Single Item Literacy Screener (SILS). Multivariable regression was used to test for association with outcomes after adjusting for age, sex, socioeconomic status (educational level and car ownership), ethnicity, first language, primary renal diagnosis, and comorbidity. In fully adjusted analyses, limited health literacy was not associated with mortality, late presentation to nephrology, dialysis modality, haemodialysis vascular access, or pre-emptive kidney transplant listing, but was associated with reduced likelihood of listing for a deceased-donor transplant (hazard ratio [HR] 0.68; 95% confidence interval [CI] 0.51-0.90), receiving a living-donor transplant (HR 0.41; 95% CI 0.19-0.88), or receiving a transplant from any donor type (HR 0.65; 95% CI 0.44-0.96). Limited health literacy is associated with reduced access to kidney transplantation, independent of patient demographics, socioeconomic status, and comorbidity. Interventions to ameliorate the effects of low health literacy may improve access to kidney transplantation.

Publication metadata

Author(s): Taylor DM, Bradley JA, Bradley C, Draper H, Dudley C, Fogarty D, Fraser S, Johnson R, Leydon GM, Metcalfe W, Oniscu GC, Robb M, Tomson C, Watson CJE, Ravanan R, Roderick P

Publication type: Article

Publication status: Published

Journal: Kidney International

Year: 2019

Volume: 95

Issue: 5

Pages: 1244-1252

Print publication date: 01/05/2019

Online publication date: 02/04/2019

Acceptance date: 20/12/2018

ISSN (print): 0085-2538

ISSN (electronic): 1523-1755

Publisher: Elsevier B.V.


DOI: 10.1016/j.kint.2018.12.021


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