The Relationship Between Health Literacy and Outcomes Before and After Kidney Transplantation.
The Relationship Between Health Literacy and Outcomes Before and After Kidney Transplantation.
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DOI：
10.1097/txd.0000000000001377
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发表时间：
2022-10
影响因子：
2.3
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中科院分区：
文献类型：
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有限的健康素养（HL）与慢性肾脏病患者的肾功能下降和死亡相关。关于HL对肾移植（KT）结局的影响知之甚少。本研究的目的是检查HL和KT结局之间的关系，包括等待率、医疗保健利用、急性排斥反应、肾移植功能、肾移植衰竭和死亡。我们对之前在我们中心收集的HL数据进行了回顾性审查。在2015年6月至2017年3月期间在明尼苏达州马约诊所接受KT评价的连续、讲英语、年龄≥ 18岁的患者的便利样本中评估了HL，作为实践改进可行性项目的一部分（n = 690）。使用针对门诊KT评估过程修改的4项简短健康素养筛查工具对HL进行评估。这4个项目评估的是填写表格的信心、阅读理解和口语读写能力。总体而言，30.4%的患者有局限性或边缘性HL。即使在调整了年龄、婚姻状况、体重指数、Charlson合并症指数或透析依赖性后，有限或边缘HL患者比充分HL患者更不可能等待KT（风险比分别为0.62和0.69）。患者HL与KT后医疗利用、急性排斥反应或肾移植功能无关。局限性或边缘性HL患者似乎发生肾移植物衰竭和KT后死亡的风险较高，但事件数量较少，且仅边缘性HL的相关性具有统计学意义。不充分的HL是常见的KT候选人和独立相关的减少等待KT。我们观察到在我们的队列中HL和移植后结果之间没有统计学显著的关系。进一步努力改善HL不足患者的沟通可能会改善KT的获得。
Limited health literacy (HL) is associated with decreased kidney function and death in patients with chronic kidney disease. Less is known about the impact of HL on kidney transplant (KT) outcomes. The aim of this study was to examine the relationship between HL and KT outcomes, including rates of waitlisting, healthcare utilization, acute rejection, renal allograft function, renal allograft failure, and death. We performed a retrospective review of HL data previously collected at our center. HL was assessed in a convenience sample of consecutive, English-speaking patients age ≥18 y who were evaluated for KT at Mayo Clinic in Minnesota between June 2015 and March 2017 as part of a practice improvement feasibility project (n = 690). HL was assessed using the 4-item Brief Health Literacy Screening Tool modified for the outpatient KT evaluation process. The 4 items assess confidence completing forms, reading comprehension, and oral literacy. Overall, 30.4% of patients had limited or marginal HL. Patients with limited or marginal HL were less likely than those with adequate HL to be waitlisted for KT (hazard ratio = 0.62 and 0.69, respectively), even after adjusting for age, marital status, body mass index, Charlson comorbidity index, or dialysis dependency. Patient HL was not associated with post-KT healthcare utilization, acute rejection, or renal allograft function. Patients with limited or marginal HL appeared to experience a higher risk of renal allograft failure and post-KT death, but the number of events was small, and the relationship was statistically significant only for marginal HL. Inadequate HL is common in KT candidates and independently associated with decreased waitlisting for KT. We observed no statistically significant relationship between HL and posttransplant outcomes in our cohort. Further efforts to improve communication in patients with inadequate HL may improve access to KT.