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Green J, Mor MK, Shields A, Sevick MA, Arnold RM, Palevsky PM, Fine MJ, Weisbord SD. Health literacy and outcomes in hemodialysis patients. Poster session presented at: American Society of Nephrology Renal Week Annual Meeting; 2011 Nov 10; Philadelphia, PA.
Background: Although limited health literacy is common among chronic hemodialysis patients, its associations with patient outcomes are not well characterized. We sought to evaluate the associations of limited health literacy with dialysis treatment adherence, hospitalizations, and mortality. Methods: Using the Rapid Estimate of Adult Literacy in Medicine (REALM), we measured the baseline health literacy of 260 chronic hemodialysis patients enrolled in a randomized clinical trial of symptom management strategies. We used Poisson regression to evaluate the independent associations of limited health literacy (REALM scores < 61) with dialysis adherence (abbreviated and missed treatments) and hospitalizations, and Cox regression to characterize the independent association of limited health literacy with mortality over a follow-up period of up to 24 months. The analyses adjusted for potential confounders and used multiple imputation to account for missing data. Results: Overall, 41 of 260 patients (16%) demonstrated limited health literacy. Limited health literacy was independently associated with a greater number of abbreviated dialysis treatments (9.1% of sessions v. 8.9% of sessions; incident rate ratio = 1.2; 95% CI 1.1-1.3) and missed treatments (3.6% of treatments v. 1.7% of treatments; incident rate ratio = 1.4; 95% CI 1.1-1.7). There was a non-statistically significant trend towards a higher risk of hospitalization among patients with limited health literacy (2.7 hospitalizations per year v. 2.2 hospitalizations per year; incident rate ratio = 1.2; 95% CI 1.0-1.4). Limited health literacy was not associated with a higher risk of mortality (hazard ratio = 1.3; 95% CI 0.6-2.9). Conclusions: Patients receiving chronic hemodialysis with limited health literacy are more likely to shorten and miss dialysis treatments and may be at greater risk for hospitalization. Interventions to address limited health literacy may increase adherence and reduce health resource utilization in this chronically ill patient population.
