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. 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.

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

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.

Background: Chronic kidney disease (CKD) patients with limited health literacy are at risk for faster disease progression. To counteract this problem, we developed ‘Grip on your Kidneys’ (GoYK), an intervention targeting patients and health care professionals. We assessed the effect on self-management, patient activation, clinical parameters, consultation quality, and the professionals’ use of health literacy strategies. We further evaluated the process. Methods: A quasi-experimental study included 147 patients with CKD and 48 professionals from Dutch general practices and nephrology clinics. Patients and professionals in the intervention group (IG) received GoYK. Control patients received care-as-usual from the participating professionals. Data were collected with questionnaires and from patient records at baseline ( T 0), 4 months ( T 1) and 9 months ( T 2). Results: No effects on self-management and patient activation were found. Conversely, at T 2, the proportion of patients with hypertension decreased in the intervention group (odds ratio = 0.45, 95% confidence interval (95%CI) [0.20, 0.99]). In the intervention group, more lifestyle topics were discussed, at T 1 (difference = 0.80, 95%CI [0.28, 1.31]) and T 2 (difference = 0.69, 95%CI [0.14, 1.25]). Furthermore, several outcomes related to consultation quality improved. Professionals in the intervention group improved the use of health literacy strategies more, at T1 (difference = 0.64, 95%CI [0.33, 0.95]) and T 2 (difference = 0.56, 95%CI [0.19, 0.93]). In general, patients and professionals considered GoYK to be useful. Conclusions: GoYK is promising, and offers a blueprint to optimize care for patients with limited health literacy. Researchers should develop and test interventions like GoYK, focusing on patients at risk for CKD, and with very low health literacy. Graphical

Background: Chronic kidney disease (CKD) is a progressive disease with high societal costs. CKD progression is influenced by patients’ health literacy, i.e., the patients’ ability to deal with information related to their own health. Objective: To assess the cost-effectiveness of Grip on Your Kidneys (GoYK), a multi-component health literacy intervention for CKD patients and their healthcare professionals. Design and Main Measures: We performed a cost-utility analysis of the GoYK intervention, measuring health outcomes in terms of quality-adjusted life years (QALYs) and costs in euros, and extrapolated the results to a lifetime horizon using a Markov model. Subjects: The GoYK study was a quasi-experimental study involving 147 patients with CKD and 48 healthcare professionals from Dutch general practices and nephrology clinics, followed over nine months. Key Results: We found that the GoYK intervention would yield a cost-saving of €28,616 and a gain of 0.37 QALYs per CKD patient across the life course. Moreover, GoYK would avert 31 deaths and 113 new dialyses per 1,000 patients in the first 10 years. These results mainly stemmed from the intervention effect on the transition to end-stage renal disease, where reductions of as little as 1% would already mean GoYK is cost-saving. The intervention remained cost-effective in multiple sensitivity and scenario analyses. Conclusions: GoYK might be a solution to slow CKD progression and, thereby, reduce CKD costs. Given these promising findings and the novelty of our study, further research should confirm our findings before broad implementation.

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.