scholarly journals Multimorbidity prevalence and patterns and their associations with health literacy among chronic kidney disease patients

2022 ◽  
Author(s):  
M. S. Gurgel do Amaral ◽  
S. A. Reijneveld ◽  
L. M. G. Meems ◽  
J. Almansa ◽  
G. J. Navis ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Health Literacy ◽  
Kidney Disease ◽  
Latent Class ◽  
Multinomial Logistic Regression ◽  
Management Skills ◽  
Adequate Health Literacy ◽  
Low Health Literacy ◽  
Crude Model ◽  
Adjusted Model

Abstract Background Health literacy is the ability to deal with information related to one’s health. Patients with low health literacy have poor disease-management skills for chronic diseases, such as chronic kidney disease (CKD). This could influence the number and combination of their diseases. Methods We included adult patients with CKD stages 1–5 from the Lifelines Study (n = 2,742). We assessed the association between low health literacy and the number and patterns of comorbidities, considering them globally and stratified by age and sex, using multinomial logistic regression and latent class analysis, respectively. Results Low health literacy was associated with a higher number of comorbidities in the crude models, and after adjustment for age, sex, eGFR, smoking, and BMI. In the crude model, the OR for low health literacy increased from 1.71 (1.25–2.33) for two comorbidities to 2.71 (2.00–3.68) for four comorbidities. In the fully-adjusted model, the associations remained significant with a maximum OR of 1.70 (1.16–2.49) for four comorbidities. The patterns of multimorbidity were similar for low and adequate health literacy, overall and by sex, bur tended to be different for patients older than 65. Older patients with low health literacy had higher comorbidity prevalence and a relatively greater share of cardiovascular, psychiatric, and central nervous system diseases. Conclusions Among CKD patients, low health literacy is associated with more multimorbidity. Health literacy is not associated with patterns of multimorbidity in younger patients, but a difference was observed in older ones. Improving low health literacy could be an intervention efficient also in decreasing multimorbidity in CKD patients. Graphical abstract

scholarly journals Multimorbidity patterns and its associations with health literacy in chronic kidney disease patients

2021 ◽  
Vol 31 (Supplement_3) ◽  
Author(s):  
M Gurgel do Amaral ◽  
SA Reijneveld ◽  
LMG Meems ◽  
J Almansa ◽  
GJ Navis ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Health Literacy ◽  
Kidney Disease ◽  
Latent Class ◽  
Multinomial Logistic Regression ◽  
Age Difference ◽  
Management Skills ◽  
Negative Effects ◽  
Adequate Health Literacy ◽  
Low Health Literacy

Abstract Background Health literacy is the ability to deal with information related to one's health. Patients with low health literacy have poor disease-management skills for chronic diseases, such as chronic kidney disease (CKD). This could influence the number and combination of their diseases. Methods We included adult patients with CKD stages 1-5 from the Lifelines Study (n = 2,742). We assessed the association between low health literacy and the number and patterns of comorbidities, overall and by age and sex, using multinomial logistic regression and latent class analysis, respectively. Results Low health literacy was associated with a higher number of comorbidities in the crude models, and after adjustment for age, sex, eGFR, smoking, and BMI. In the crude model, the OR for low health literacy increased from 1.71 (1.25 to 2.33) for two comorbidities to 2.71 (2.00 to 3.68) for four comorbidities. In the fully-adjusted model, the associations remained significant with a maximum OR of 1.70 (1.16 to 2.49) for four comorbidities. The patterns of multimorbidity were similar for low and adequate health literacy, overall and by sex, and slightly different for patients older than 65. Older patients with low health literacy had higher comorbidity prevalence and a relatively greater share of cardiovascular, psychiatric, and central nervous system diseases. Conclusions This study showed that CKD patients have a high prevalence of comorbidities. Patients with low health literacy are more likely to have a higher number of comorbidities than patients with adequate health literacy. Moreover, the multimorbidity patterns are similar for both groups of health literacy, differing slightly at older ages. This age difference suggests that the negative effects of low health literacy develop when aging. Therefore, low health literacy could be an intervention target to decrease multimorbidity along the life course of CKD patients. Key messages Among CKD patients, low health literacy is associated with more multimorbidity. Health literacy does not affect patterns of multimorbidity in younger patients, but it does slightly in older ones.

scholarly journals Do Uncontrolled Hypertension, Diabetes, Dyslipidemia, and Obesity Mediate the Relationship between Health Literacy and Chronic Kidney Disease Complications?

2021 ◽  
Vol 18 (10) ◽  
pp. 5235
Author(s):  
Matheus Gurgel do Amaral ◽  
Sijmen A. Reijneveld ◽  
Josue Almansa ◽  
Gerjan Navis ◽  
Andrea F. de Winter
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Health Literacy ◽  
Kidney Disease ◽  
Uncontrolled Hypertension ◽  
Management Skills ◽  
Low Health Literacy ◽  
Adult Participants ◽  
Uncontrolled Diabetes ◽  
Age And Sex

Health literacy is the ability to deal with information related to one’s health. Patients with low health literacy and chronic diseases, such as chronic kidney disease (CKD), have poor disease-management skills, which could lead to complications. We used logistic regressions and structural equational modeling to assess whether low health literacy is associated with the development of cardiovascular disease and mortality in patients with CKD, and whether this association is mediated by the presence of uncontrolled hypertension, diabetes, dyslipidemia, obesity, or albuminuria. Data from 2742 adult participants with CKD from the Lifelines study were analyzed at baseline and after approximately four years. Low health literacy was associated with cardiovascular disease and mortality in the crude models, with OR and 95%CI of 1.93 (1.46 to 2.55) and 1.59 (1.08 to 2.36), respectively. After adjustment for age and sex, low health literacy was only associated with cardiovascular disease (OR 1.76 (1.31 to 2.23)). This association was mediated by uncontrolled diabetes (27.1%) and obesity (8.0%). Low health literacy is associated with the development of cardiovascular disease after adjustment for age and sex, and this association is mediated by uncontrolled diabetes and obesity.

Low Health Literacy is Associated with the Onset of CKD during the Life Course

2021 ◽  
Vol 32 (6) ◽  
pp. 1436-1443
Author(s):  
Matheus S. Gurgel do Amaral ◽  
Sijmen A. Reijneveld ◽  
Bas Geboers ◽  
Gerjan J. Navis ◽  
Andrea F de Winter
Keyword(s):  
Older Adults ◽  
Health Literacy ◽  
High Body Mass Index ◽  
Total Sample ◽  
Population Based ◽  
Adequate Health Literacy ◽  
Low Health Literacy ◽  
Crude Model ◽  
The Life Course

BackgroundHealth literacy, the ability to deal with information related to one’s health, is a predictor of health outcomes in CKD. However, research has not explored whether low health literacy predicts the onset of CKD.MethodsWe used data from participants of Lifelines, a prospective population-based cohort study of individuals living in The Netherlands, to assess the share of individuals with low health literacy by eGFR category, whether low health literacy is associated with CKD onset in the general population and in the subgroup of older adults, and whether established CKD risk factors mediate this association.ResultsIn the total sample of 93,885 adults (mean follow-up 3.9 years), low health literacy was more likely among individuals in worse eGFR categories, increasing from 26.4% in eGFR category 1 to 50.0% in category 5 (P=0.02). Low health literacy, compared with adequate health literacy, was associated with the onset of CKD in the total sample (3.0% versus 2.1%) and in the subgroup of older adults (13.4% versus 11.3%), with odds ratios (ORs) of 1.44 (95% confidence interval (95% CI), 1.31 to 1.59) and 1.21 (95% CI, 1.04 to 1.41), respectively. After adjustment for sex, age, education, and income, health literacy was associated with CKD onset only in older adults (OR, 1.25; 95% CI, 1.04 to 1.50). This association was mediated by hypertension and high body mass index (BMI) in the crude model, but only by BMI after adjustment (with BMI explaining 18.8% of the association).ConclusionsLow health literacy is a risk factor for CKD onset among older adults, which suggests that CKD prevention might benefit from strategies to address low health literacy.

Abstract P038: Characterizing Patterns Of Fruits And Vegetables Intake In Adults With And Without Chronic Kidney Disease In The United States

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Shirin Pourafshar ◽  
Binu Sharma ◽  
Sibylle Kranz ◽  
Indika Mallawaarachchi ◽  
Elizabeth Kurland ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Fruits And Vegetables ◽  
Latent Class ◽  
Multinomial Logistic Regression ◽  
Starch Content ◽  
The United States ◽  
Nhanes Iii ◽  
The Us ◽  
High Starch

Background: Due to concerns about hyperkalemia, the recommendation for patients with chronic kidney disease (CKD) is to limit intakes of foods high in potassium, including certain types of nuts, fruits and vegetables (F&V). Detailed patterns of F&V intake have not been described in patients with CKD, limiting our ability to study higher or lower risk patterns. In this study, we aimed to characterize the patterns of F&V intake in adults with and without CKD in a nationally representative sample of the US. Methods: We included 16,183 adults, with (n= 3,225) and without (n= 12,958) CKD based on eGFR and albuminuria from the Third National Health and Nutrition Examination Survey (NHANES III). We calculated counts of different types of F&V consumed by the participants according to a 24-h recall interview reported in the NHANES III Individual Food File. Based on their phytonutrient and starch content, F&V were then categorized into: rich in polyphenols; rich in carotenoids; rich in glucosinolates, and high in starch. We also categorized consumption of legumes and nuts. Patterns of legumes, nuts, and F&V intake were identified using latent class analysis (LCA; LCCA package, R 3.0.1). We evaluated differences in serum carotenoids, vitamins A, E, and C as objective biomarkers to help validate patterns. Multinomial logistic regression incorporating survey weights was used to adjust association between CKD status and F&V patterns (SAS Institute, V.9.4). Results: LCA analysis classified the food consumption into 3 distinct patterns: low F&V/low starch; moderate F&V/high starch; and high F&V/moderate starch. Consumption of legumes and nuts was low in all three patterns. Pattern of higher F&V consumption had higher serum levels of carotenoids, vitamins A, E, and C (p for difference across patterns <0.0001). Unadjusted patterns of consumption were not different in patients with vs. without CKD (p=0.654). After adjustment for ethnicity, gender, body mass index, waist circumference, diabetes, and hypertension, patients with CKD were more likely to consume moderate F&V/ high starch (OR=1.23, p=0.0316) or low F&V/starch (OR=1.34, p=0.0001) compared to patients without CKD. Conclusions: Utilizing the LCA analysis and regression, we found higher likelihood of consuming low F&V patterns in patients with vs. without CKD in the US. Further studies are needed to evaluate outcomes to understand risks of benefits of F&V patterns for patients with CKD.

scholarly journals A Linguistic Analysis of Health Literacy Demands of Chronic Kidney Disease Patient Education Materials

2018 ◽  
Vol 2 (1) ◽  
pp. e1-e14
Author(s):  
Suzanne Morony ◽  
Angela C. Webster ◽  
Rachelle Buchbinder ◽  
Suzanne Kirkendall ◽  
Kirsten J. McCaffery ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Health Literacy ◽  
Patient Education ◽  
Kidney Disease ◽  
Chronic Kidney Disease Patient ◽  
Disease Patient ◽  
Linguistic Analysis

Abstract P169: Health Literacy and Outcomes in Heart Failure: a Prospective Community Study

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Matteo Fabbri ◽  
Kathleen Yost ◽  
Lila Finney Rutten ◽  
Sheila Manemann ◽  
Susan Weston ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Literacy ◽  
Proportional Hazards ◽  
International Classification Of Diseases ◽  
Cox Proportional Hazards ◽  
Low Literacy ◽  
Adequate Health Literacy ◽  
Low Health Literacy ◽  
Increased Risk

Background: Growing evidence documents the association between low health literacy and poorer health outcomes. However, less is known about the relationship between health literacy and outcomes among patients with heart failure (HF). We examined the association of health literacy with risk of hospitalization and mortality in patients with HF. Methods: Residents in an 11-county region in southeastern Minnesota with incident HF from 1/01/2013 to 3/31/2015 were identified using the International Classification of Diseases, Ninth Revision code 428 (n=3715) and prospectively surveyed to measure health literacy using established screening questions. A total of 1992 patients returned a survey (response rate 54%); 1779 patients with complete clinical data and adequate follow up were retained for analysis. Health literacy, measured as a composite on three 5-point scales, was categorized as adequate (≤ 10) or low (> 10). Cox proportional hazards regression and Andersen-Gill models were used to determine the association of health literacy with mortality and hospitalization. Results: Among 1779 patients (mean age 74, 53% male), 10% had low health literacy. After a mean follow-up of 8±4 months, 72 deaths and 600 hospitalizations occurred. Low health literacy was associated with increased mortality and hospitalizations (Figure). After adjusting for age, sex, comorbidity, education and marital status, the hazard ratio for death and hospitalization in patients with low health literacy was 2.84 (95% CI: 1.63, 4.96) and 1.43 (95% CI: 1.04, 1.96) respectively, compared to patients with adequate health literacy. Conclusions: Low health literacy is associated with increased risk of hospitalization and death among patients with HF. Health literacy is critical to the self-management demands of living with heart failure. Evaluation of health literacy in the clinical setting may guide inventions to target patients with low literacy.

Association Between Longitudinal Blood Pressure Trajectory and the Progression of Chronic Kidney Disease: Results From the KNOW-CKD

Hypertension ◽  
2021 ◽  
Author(s):  
Young Su Joo ◽  
Hyung Woo Kim ◽  
Ki Heon Nam ◽  
Jee Young Lee ◽  
Tae Ik Chang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Primary Outcome ◽  
Latent Class ◽  
Mixed Model ◽  
Hazards Model ◽  
Trajectory Group ◽  
End Stage

Studies on the longitudinal temporal trend of blood pressure (BP) and its impact on kidney function are scarce. Here, we evaluated the association of dynamic changes in systolic blood pressure (SBP) over time with adverse kidney outcomes. We analyzed 1837 participants from the KNOW-CKD (Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease). The main exposure was 3 distinct SBP trajectories determined by the latent class mixed model (decreasing, stable, and increasing) using 3 SBP measurements at 0, 6, and 12 months. The primary outcome was CKD progression, defined as a composite of halving estimated glomerular filtration rate from baseline value or onset of end-stage kidney disease. SBP declined from 144 to 120 mm Hg in the decreasing SBP trajectory group and rose from 114 to 136 mm Hg in the increasing trajectory group within 1 year. During 6576 person-years of follow-up (median, 3.7 years), the composite outcome occurred in 521 (28.4%) participants. There were fewer primary outcome events in the decreasing (30.6%) and stable (26.5%) SBP trajectory groups than in the increasing trajectory group (33.0%). In the multivariable-adjusted cause-specific hazards model, increasing SBP trajectory was associated with a 1.28-fold higher risk for adverse kidney outcome compared with stable SBP trajectory. However, the risk for the primary outcome did not differ between the decreasing and stable SBP trajectory groups. In this longitudinal CKD cohort study, compared with stable SBP trajectory, increasing SBP trajectory was associated with higher risk for adverse kidney outcome, whereas decreasing SBP trajectory showed similar risk.

scholarly journals Exploring health literacy in patients with chronic kidney disease: a qualitative study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Une Elisabeth Stømer ◽  
Astrid Klopstad Wahl ◽  
Lasse Gunnar Gøransson ◽  
Kristin Hjorthaug Urstad
Keyword(s):  
Chronic Kidney Disease ◽  
Health Literacy ◽  
Kidney Disease ◽  
Qualitative Study

scholarly journals The ABCs of Kidney Disease: Knowledge Retention and Healthcare Involvement

2021 ◽  
Vol 8 ◽  
pp. 237437352110652
Author(s):  
Daphne H. Knicely ◽  
Kristina Rinaldi ◽  
Shani Snow ◽  
Carmen Elena Cervantes ◽  
Michael J. Choi ◽  
...  
Keyword(s):  
Health Literacy ◽  
Kidney Disease ◽  
Education Program ◽  
Knowledge Retention ◽  
Office Visits ◽  
Structured Education ◽  
Disease Knowledge ◽  
Education Class ◽  
Low Health Literacy ◽  
Consistent Manner

Low health literacy in the chronic kidney disease population results in lower rates of pre-dialysis preparation and understanding of management to slow progression. The ABCs of Kidney Disease education class provided education in a more consistent manner outside of routine office visits. We aimed to study whether a structured education program would increase kidney disease-specific knowledge and healthcare involvement. Knowledge retention at least 6 months after the class assessed by the Kidney Disease Knowledge Surveys (KiKS) and healthcare involvement based on surveys sent to referring providers were found to have increased. Incorporation of a structured education program would be important for providers to improve long-term knowledge and lead to greater healthcare involvement. Providing an education class outside of the routine office visits will provide a greater impact on health literacy.

scholarly journals Patient empowerment through a user-centered design of an electronic personal health record: a qualitative study of user requirements in chronic kidney disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Esmaeel Toni ◽  
Habibollah Pirnejad ◽  
Khadijeh Makhdoomi ◽  
Azam Mivefroshan ◽  
Zahra Niazkhani
Keyword(s):  
Chronic Kidney Disease ◽  
Health Literacy ◽  
Kidney Disease ◽  
Qualitative Study ◽  
Personal Health Record ◽  
Self Management ◽  
Personal Health ◽  
Health Record ◽  
User Centered Design ◽  
Electronic Personal Health Record

Abstract Background To improve chronic disease outcomes, self-management is an effective strategy. An electronic personal health record (ePHR) is a promising tool with the potential to support chronic patient’s education, counseling, and self-management. Fitting ePHRs within the daily practices of chronic care providers and chronic patients requires user-centered design approaches. We aimed to understand users’ needs and requirements in chronic kidney disease (CKD) care to consider in the design of an ePHR to facilitate its implementation, adoption, and use. Methods A qualitative study was conducted in a major Iranian nephrology center including inpatient and outpatient settings in 2019. We conducted 28 semi-structured interviews with CKD patients, nurses, and adult nephrologists. To confirm or modify the requirements extracted from the interviews, a focus group was also held. Data were analyzed to extract especially those requirements that can facilitate implementation, adoption, and sustained use based on the PHR adoption model and the unified theory of acceptance and use of technology. Results Participants requested an ePHR that provides access to up to date patient information, facilitates patient-provider communication, and increases awareness about patient individualized conditions. Participants expected a system that is able to cater to low patient e-health literacy and high provider workload. They requested the ePHR to include purposeful documentation of medical history, diagnostic and therapeutic procedures, tailored educational content, and scheduled care reminders. Messaging function, tailored educational content to individual patients’ conditions, and controlled access to information were highly valued in order to facilitate its implementation, adoption, and use. Conclusions We focused on the ePHR’s content and functionalities in the face of facilitators and/or barriers envisioned for its adoption in nephrology care. Designers and implementers should value CKD patients’ needs and requirements for self-management such as providing personalized education and counseling (on the basis of their condition and risk factors), health literacy, and disease progression levels. The socio-technical aspects of care also need further attention to facilitate ePHR’s adoption.

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