Supporting CKD-patients with limited health literacy

Chronic kidney disease (CDK) is a growing problem. With a prevalence of 8-16% worldwide it’s one of the most abundant diseases. Because elderly and patients with welfare-related diseases, such as Diabetes and hypertension, are at risk, the prevalence of CKD is estimated to grow (Jha et al. 2013). Strict diet and fluid intake restrictions(Silva et al. 2014), lifestyle advises and different kinds of medication are important aspects of the treatment of CKD. Next to that patients often face comorbidities and difficult decisions about intensive renal replacement therapies (Murtagh et al. 2007).

To improve treatment, support and self-management in CKD, special attention for health literacy is needed. Limited health literacy (LHL) in patients with CKD is common. The prevalence is estimated between 9% and 32% (Fraser et al. 2013). Health literacy is defined as ‘the degree to which people are able to access, understand, appraise and communicate information to engage with the demands of different health contexts to promote and maintain good health across the life course’ (Kwan, 2006)
University Medical Centre Groningen (UMCG) and Dialysis Center Groningen (DCG) together initiated research on LHL in CKD. A systematic review (not yet finished) shows the negative impact of LHL on individual outcomes. People with LHL had lower serum albumin(Dodson et al. 2016), lower estimated glomerular filtration rate (eGFR), higher urine protein, all measures for kidney health (Ricardo et al. 2014). Furthermore LHL in CKD is associated with a higher prevalence of co-morbidities (Taylor et al. 2016) and psychological problems (Dodson et al. 2016).

An explanation for the above might be found in the ability of LHL-patients to manage their disease. In dialysis patients a relation was shown between self-registered self-management of Diabetes and limited communicative and critical health literacy. LHL was also associated with an increased incidence of missed dialysis treatments, more emergency department visits and hospitalization (Green et al. 2013).

The next step of this research focuses on interventions to improve individual outcomes in LHL-CKD-patients. Patient-centered interventions with special attention to LHL are developed and tested in clinical practice.