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Abstract: TH-PO1083

Health Literacy and Rapid Kidney Function Decline

Session Information

Category: CKD (Non-Dialysis)

  • 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention


  • Kambhampati, Rekha, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Kuczmarski, Marie, University of Delaware, Newark, Delaware, United States
  • McAdams-DeMarco, Mara, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Han, Dingfen, Johns Hopkins, Baltimore, Maryland, United States
  • Zonderman, Alan B., Intramural Research Program, NIA, NIH, Baltimore, Maryland, United States
  • Evans, Michele Kim, National Institutes of Health/National Institute on Aging, Baltimore, Maryland, United States
  • Crews, Deidra C., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Health literacy is the ability to understand basic health information. Cross-sectional studies have revealed an association between limited health literacy and lower eGFR in those with CKD. The association of health literacy and kidney function over time has not been described, therefore, we conducted a prospective analysis of this question.


We studied 1,603 Healthy Aging in Neighborhoods of Diversity across the Life Span study participants with preserved kidney function (eGFR ≥ 60 mL/min/1.73 m2). A Rapid Estimate of Adult Literacy in Medicine test score of ≤ 60 indicated limited health literacy. We used multivariable logistic regression to assess the association of health literacy with rapid kidney function decline (eGFR loss ≥ 3 mL/min/1.73 m2 per year over median of 5 years).


Participants’ mean age was 48 years. The prevalence of limited health literacy was 29.7% (n=476). Participants with limited health literacy were more likely to be male (50.4% vs 37.1%), African American (74.8% vs 52.4%), living in poverty (51.9% vs 31.2%), have less educational attainment (mean 11.3 vs 13.3 years of schooling), and be current smokers (53.1% vs 41.5%) than persons with adequate health literacy (p<0.05 for all). Both literacy groups had similar baseline levels of eGFR, systolic BP, self-reported hypertension, and diabetes. A total of 218 (13.6%) participants had rapid kidney function decline at follow-up. The unadjusted odds of rapid kidney function decline among those with limited health literacy compared to adequate health literacy was 1.20 (95% CI: 0.81-1.77). After adjusting for age, sex, race, poverty status, education, smoking status, BP, and diabetes, there was still no association (OR 0.99, 95% CI: 0.67-1.47). A series of alternate outcomes (rapid eGFR decline of ≥3% decrease per year, eGFR decrease of ≥25% over a median of 5 years, incident eGFR<60, and incident albuminuria) revealed results consistent with the primary outcome.


There was no association between health literacy and various measures of kidney function decline in this cohort. Although previous cross-sectional analyses have shown an association between health literacy and kidney function, this finding was not present in this prospective analysis. Factors other than health literacy may have more influence over early loss of kidney function.


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