Dominic Taylor|Simon Fraser|Chris Dudley|Gabriel C. Oniscu|Charles Tomson|Rommel Ravanan|Paul Roderick
Health literacy and patient outcomes in chronic kidney disease: a systematic review
North Bristol NHS Trust|University of Southampton|University of Southampton|North Bristol NHS Trust|Edinburgh Royal Infirmary|Freeman Hospital|North Bristol NHS Trust|North Bristol NHS Trust
limited health literacy affects 25 people chronic kidney disease ckd may reduce selfmanagement skills resulting poorer clinical outcomes disproportionately affecting people low socioeconomic status nonwhite ethnicity limited health literacy may promote health inequitywe performed systematic review quantitative studies health literacy clinical outcomes among adults ckda total 29 studies 13 articles 16 conference abstracts included one included nonusa patients 29 studies 5 cohort studies 24 crosssectional 18 300 patients studied 4367 nondialysis ckd 13 202 dialysis 390 transplant 341 unspecified median study size 127 interquartile range iqr 92238 480 iqr 2602392 cohort studies median proportion nonwhite participants 48 iqr 1770 six health literacy measures used outcomes included patient attributes care processes clinicallaboratory parameters hard clinical outcomes limited health literacy significantly independently associated hospitalizations emergency department use missed dialysis sessions cardiovascular events mortality cohort studies study quality high 1 study moderate 3 studies poor 25 studies limited sampling methods variable adjustment confounders reduced methodological detail given conference abstractsthere limited robust evidence causal effects health literacy patient outcomes ckd available evidence suggests associations adverse clinical events increased healthcare use mortality prospective studies required determine causal effects health literacy outcomes ckd patients examine relationships socioeconomic status comorbidity health literacy ckd outcomes intervention development evaluation determine whether health literacy modifiable determinant poor outcomes ckd