Health Literacy May affect Transplantation Chances

Inadequate health literacy is common in ESRD patients and is linked to a lower rate of referral for transplant evaluation, reports a study in the Clinical Journal of the American Society of Nephrology.

Vanessa Grubbs, MD, and colleagues at the University of California, San Francisco, administered a brief test of functional health literacy to 62 black and white patients on maintenance hemodialysis. The results suggested an inadequate level of health literacy—“the capacity to obtain, process, and understand basic health information and services to make appropriate health decisions”—in about one-third of patients. Older adults had lower health literacy scores, as did lower-income and less educated patients.

On adjusted analysis, patients with inadequate health literacy were 78 percent less likely to be referred for transplant evaluation. After referral, mean time to waitlisting was 6.6 months for patients with inadequate health literacy, compared with 2.1 months for those with adequate health literacy. There was no significant difference in the likelihood of being waitlisted.

The reasons for the difference in referral rate are unknown, although nephrologists’ perceptions of the patient’s ability to keep up with posttransplant care could have an impact. Inadequate health literacy “may play a potentially important and modifiable role in equitable access to kidney transplantation,” the investigators conclude [Grubbs V, Gregorich S, Perez-Stable S, and Hsu C-y: Health literacy and access to kidney transplantation. Clin J Am Soc Nephrol 2009; 4:195–200].