Maria Majernikova

Health-related quality of life (HRQoL) is an important health indicator in chronic diseases like kidney diseases. Health literacy (HL) may strongly affect HRQoL, but evidence is scarce. Therefore, we assessed the associations of HL with HRQoL in dialysed patients. We performed a cross-sectional study in 20 dialysis clinics across Slovakia (n = 542 patients, mean age = 63.6 years, males = 60.7%). We assessed the association of categorised HL (low, moderate, high) with the SF36 physical component score (PCS) and mental component score (MCS) using generalised linear models adjusted for age, gender, education, and comorbidity (Charlson Comorbidity Index, CCI). We found significant associations of HL with PCS and MCS in dialysed patients, adjusted for age, gender, education, and CCI. Low-HL patients had a lower PCS (B = −3.27, 95%-confidence interval, CI: −5.76/−0.79) and MCS (B = −6.05, 95%-CI: −8.82/−3.29) than high-HL patients. Moderate-HL patients had a lower MCS (B = −4.26, 95%-CI: −6.83/−1.69) than high-HL patients. HL is associated with physical and mental HRQoL; this indicates that dialysed patients with lower HL deserve specific attention and tailored care to have their HRQoL increased.

Health-related quality of life (HRQoL) is likely to deteriorate with the progression of chronic kidney disease (CKD). This change may be worsened by low health literacy (HL). We performed a longitudinal study at over 20 dialysis clinics in Slovakia (n = 413; mean age = 64.8 years; males = 58.4%). We assessed the association of three HL groups with a change in HRQoL over two years using binary logistic regression adjusted for type of vascular access, dialysis effectiveness, comorbidity, age and gender. We found that patients with low HL had poorer HRQoL at baseline in comparison to high-HL patients. We did not find significant associations of lower HL with the deterioration of mental or physical HRQoL after two years. In the adjusted model, patients with lower HL were not more likely to have deteriorated physical (low-HL patients: odds ratio/95% confidence interval: 0.99/0.53–1.84; moderate-HL patients: 0.97/0.55–1.73) or mental HRQoL (low-HL patients: 1.00/0.53–1.87; moderate-HL patients: 0.95/0.53–1.70) in comparison to high-HL patients. The HRQoL of lower-HL patients is worse at baseline but develops similarly to that of high-HL patients during dialysis treatment. Their relative HRQoL, thus, does not worsen further, but it does not improve either. Tailoring care to their needs may help to decrease the burden of low HL in dialysed patients.

Objectives: Chronic kidney disease (CKD) strongly affects patients’ health-related quality of life (HRQoL), mostly in the advanced stages of CKD. Health literacy (HL) may affect this association, in particular for some aspects of HRQoL. The aim of this study is to compare the profiles of HRQoL in dialyzed patients with varying HL.Methods: We obtained data on HL using the Health Literacy Questionnaire (HLQ) and on HRQoL using the Kidney Disease Quality of Life – Short Form (KDQoL-SF 1.3) in a multicentre cross-sectional study in 20 dialysis clinics in Slovakia (n = 542; mean age = 63.6 years; males: 60.7%). We compared HRQoL for three HL groups using ANOVA and the Kruskal-Wallis test.Results: Patients with low HL reported worse HRQoL than patients with moderate and high HL. The greatest differences between HL groups were found in the scales Effect of kidney disease, Cognitive function, Quality of social interaction, Social support, Dialysis staff encouragement, Patient satisfaction, Physical functioning, Pain, Emotional well-being and Social function. p-values in all cases were Conclusion: Patients with low HL have a worse HRQoL in several domains than patients with a higher HL. Increasing HL capacities and better supporting patients with low HL should thus be given priority to support their HRQoL and at least maintain its level.

Limited health literacy (HL), depression and anxiety are common in dialyzed patients and affect health outcomes and self-management. We explored whether depression and anxiety mediate the association of HL with diet non-adherence (DN-A) in dialyzed patients. We performed a cross-sectional study in 20 dialysis clinics in Slovakia (n = 452; mean age: 63.6 years; males: 60.7%). Hierarchical cluster analysis was performed to create three HL groups. Logistic regression adjusted for age, gender and education was used to explore whether depression and anxiety mediate the association of HL with DN-A. Patients in the moderate HL group were more likely to be non-adherent to diet (OR (Odds Ratio)/95% CI: 2.19/1.21–3.99) than patients in the high HL group. Patients in the low HL and moderate HL group more likely reported depression or anxiety. Patients reporting depression (OR/95% CI: 1.94/1.26–2.98) or anxiety (OR/95% CI: 1.81/1.22–2.69) were more likely to be non-adherent with diet. Adjustment for depression reduced the association between moderate HL and DN-A by 19.5%. Adjustment for anxiety reduced the association between moderate HL and DN-A by 11.8%. Anxiety and depression partly mediated the association of HL with DN-A. More attention should be paid to treating patients’ psychological distress to ensure adequate adherence with recommended diet.

Effective vascular access (VA) is an essential condition for providing hemodialysis, affecting patients’ health outcomes. We aim to explore how health literacy (HL) as a non-clinical factor is associated with the decision-making process regarding VA type selection. Using data from 20 dialysis centers across Slovakia (n = 542, mean age = 63.6, males = 60.7%), the association of HL with type of VA (arteriovenous fistula (AVF) vs. central venous catheter (CVC)) was analyzed using a logistic regression model adjusted for sociodemographic characteristics and comorbidity. Sociodemographic data and data on nine domains of HL were collected by questionnaire. Data on VA and comorbidity were obtained from a medical records. Patients with a greater ability to engage with healthcare providers (odds ratio (OR): 1.34; 95% confidence interval (CI): 1.00–1.78), those with a better ability to navigate the healthcare system (OR: 1.41; 95% CI: 1.08–1.85), those more able to find good health information (OR: 1.52; 95% CI: 1.15–2.03), and those who understand it well enough to know what to do (OR: 1.52; 95% CI: 1.12–2.06) are more likely to have AVF. Patients’ HL is associated with the type of VA; therefore, it should be considered in the decision-making process regarding the selection of the type of VA, thereby informing strategies for improving patients’ HL and doctor–patient communication.

Non-adherence to dietary and fluid intake recommendations (NADFIR) is an important factor for the effective treatment of dialyzed patients and may be hindered by low health literacy (HL). Therefore, we assessed whether low HL of dialyzed patients is associated with their NADFIR. We performed a multicentric cross-sectional study in 20 dialysis clinics in Slovakia (n = 452; response rate: 70.1%; mean age = 63.6 years; males: 60.7%). We assessed the association between nine domains of HL and non-adherence (high serum potassium, high serum phosphate, relative overhydration, and self-reported NADFIR) using general linear models adjusted for age and gender. Moreover, we assessed the moderation by socioeconomic status (SES). We found higher NADFIR among patients with less sufficient information for health management (high serum phosphate level; odds ratio (OR): 0.77; 95% confidence interval (CI): 0.63–0.94), with a lower ability to actively manage their health (self-reported diet non-adherence; OR: 0.74; 95% CI: 0.62–0.89), and those less able to actively engage with healthcare providers (overhydrated; OR: 0.78; 95% CI: 0.65–0.94). Moreover, SES modified this relation. Low HL affects the adherence of dialyzed patients. This shows a need to support patients with low HL and to train healthcare providers to work with these patients, taking into account their SES.

Background: Roma health has not been studied systematically. Thus far, it has been shown that Roma compared to non-Roma have a significantly higher likelihood of getting end-stage renal disease and that their chances for survival on dialysis are lower. Evidence is lacking regarding morbidity between Roma and non-Roma. The aim was to compare the health status of dialyzed Roma and non-Roma using the Charlson comorbidity index (CCI). All Slovak dialysis centers for adults were asked to fill in a questionaire with demographic and clinical data, including comorbidity. Cross-sectional analysis of 2082 patients with an average age of 63.8 ± 13.8 years was performed. Comorbidity was expressed as the CCI, and ethnic differences were calculated. Linear regression was performed to adjust for differences in gender and age in both ethnic groups. Roma represented 13.0% of the whole dialyzed population (n = 270). Comorbidity expressed as CCI was significantly lower in the Roma population (p < 0.001). After adjusting for gender and age, ethnicity failed to be associated with the CCI in the linear regression analysis (p = 0.965, variance of the model—adjusted R² 38.6%). The health status of dialyzed Slovak Roma does not differ cross-sectionally when adjusted for age and gender from the health status of dialyzed non-Roma.

Background.Findings on the association between posttransplant anemia (PTA) and mortality in posttransplant patients are scarce. This study explored whether PTA shortly after kidney transplantation (KT) predicts mortality at up to 10 years’ follow-up, stratified for chronic kidney disease (CKD) stages.Methods.PTA was divided into 3 categories according to the hemoglobin (Hb) value: severe (Hb < 10 g/dl), mild (10.0 g/dl ≤ Hb < 11.9 g/dl), or no PTA (Hb ≥ 12 g/dl). CKD stages were estimated using the CKD-EPI formula and divided into 2 groups: CKD1-2 and CKD3–5. Cox regression, stratified according to CKD, was performed to identify whether different categories of PTA predicted mortality in KT recipients.Results.Age, being female, and both mild and severe PTA contributed significantly to the Cox regression model on mortality in CKD1-2. In the Cox regression model for mortality in CKD3–5, age and severe PTA contributed significantly to this model.Conclusion.PTA shortly after KT increased the risk of mortality at up to 10 years’ follow-up. Even mild PTA is associated with a 6-fold higher risk of mortality and severe PTA with a 10-fold higher risk of mortality in CKD1-2. Clinical evaluation and treatment of anemia might reduce the higher risk of mortality in patients with PTA in early stages of CKD after KT.

Anemia is a predictor of mortality and of self-rated health (SRH). However, studies on the relationship between SRH and changes in hemoglobin (Hb) value over time stratified by chronic kidney disease (CKD) stages are lacking. The aim is to explore whether a change in Hb-value over time associates with SRH at up to 8-year follow-up, stratified for CKD stages. A prospective study with a baseline measurement between the 3rd and 12th month after KT was performed on 337 consecutive patients. Demographic and clinical data were retrieved from medical records. CKD stages were estimated using the CKD-EPI formula and divided into two groups: CKD1-2 and CKD3-5. Generalized estimating equations (GEE) were performed to identify associations of SRH at follow-up in both CKD groups. Male gender, new-onset diabetes mellitus after KT (NODAT), a decrease in estimated glomerular filtration rate (eGFR) and Hb-value over time contributed significantly to the GEE model on SRH at follow-up in CKD1-2. For SRH at follow-up in CKD3-5, older age, male gender and chronic renal allograft dysfunction (CRAD) contributed significantly to the GEE model. At up to 8-year follow-up, male gender, NODAT, a decrease in eGFR and Hb-value over time are associated with poorer SRH in CKD1-2. In such patients, we suggest monitoring slight deteriorations in eGFR and Hb-values. In CKD3-5, higher age, male gender and higher presence of CRAD are associated with poorer SRH at up to 8-year follow-up. In these patients, adequate treatment would slow down CRAD progression

Background: This study explored whether self-rated health (SRH) shortly after kidney transplantation (KT) predicts mortality and graft loss at up to 10 years’ follow-up. Methods: A total of 276 patients shortly after successful KT were interviewed. SRH was measured using the first item of the SF-36 questionnaire and divided into three tertiles: poor, average and excellent health. Clinical data were retrieved from medical records. Cox regression was used to identify whether different levels of SRH predicted mortality and graft loss in transplant recipients. The observation period was up to 10 years. Results: Poor SRH (HR 11.1, p < 0.001), average SRH (HR 4.21, p < 0.05), estimated glomerular filtration rate (HR 0.26, p < 0.05) and age (HR 1.04, p < 0.05) were significantly associated with mortality. Similarly, poor SRH (HR 6.4, p < 0.001), average SRH (HR 3.6, p < 0.05), new-onset diabetes mellitus after KT (HR 3.3, p < 0.05) and chronic renal allograft dysfunction (HR 3.7, p < 0.00) were significantly associated with graft loss. Conclusion: Poor SRH shortly after transplantation indicates an increased risk of mortality and graft loss at up to 10 years’ follow-up. SRH could be an inexpensive and reliable indicator for starting diagnostic and/or treatment strategies. The usefulness of SRH compared to other global clinical measures predicting mortality and graft loss should also be studied.