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

Matheus S. Gurgel do Amaral; Sijmen A. Reijneveld; Bas Geboers; Gerjan J. Navis; Andrea F de Winter

doi:10.1681/ASN.2020081155

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Visual Abstract

Significance Statement

Low health literacy, the decreased ability to deal with information related to one’s health, has been associated with poor outcomes in patients with CKD, but research has not explored whether low health literacy is associated with the onset of CKD. Using data from a prospective cohort study of 93,885 community-dwelling adults living in The Netherlands, the authors showed that low health literacy was associated with the onset of CKD in older adults, and that this association was partially explained by the presence of a high body mass index (BMI). Moreover, individuals with worse renal function were more likely to have low health literacy. These results suggest that measures to address low health literacy, notably over the control of BMI, might help prevent the development of CKD.

Abstract

Background Health 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.

Methods We 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.

Results In 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).

Conclusions Low 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.

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