Patient Dialysis Knowledge Linked to Arteriovenous Access

Patients with lower levels of knowledge about chronic hemodialysis are less likely to have arteriovenous access for dialysis, according to a study in the Clinical Journal of the American Society of Nephrology.

The prospective cohort study included 490 adult patients starting chronic hemodialysis and followed up for six months. The Chronic Hemodialysis Knowledge Survey (CHeKS) was used to assess dialysis knowledge; the median score was 65 percent out of 100 percent. Older, nonwhite, and less educated patients had lower scores.

Dialysis knowledge was significantly related to dialysis access type. On adjusted analysis, the likelihood of having arteriovenous fistula or graft access at the start of dialysis increased by about one-third per 20 percent increase in CHeKS score. A similar association was noted for access at six months. The CHeKS score was not significantly related to most laboratory measures, except for a modest association with serum albumin.

Low dialysis knowledge appears to be a risk factor for not having arteriovenous access at the start of dialysis and at follow-up. Evaluation of patient knowledge may provide a quick tool for identifying at-risk patients who could benefit from targeted educational interventions, the authors believe [Cavanaugh KL, Wingard RL, Hakim RM, Elasy TA, Ikizler A: Patient dialysis knowledge is associated with permanent arteriovenous access use in chronic hemodialysis. Clin J Am Soc Nephrol 2009; 4:950–956].