Abstract: SA-OR032
Understanding Health Information in English and "Nonoptimal" Dialysis Initiation: Insights from the New Medical Evidence Form
Session Information
- Diversity and Equity in Kidney Health: Research and Cases
November 08, 2025 | Location: Room 361A, Convention Center
Abstract Time: 05:10 PM - 05:20 PM
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
Authors
- Wetmore, James B., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
- Liu, Jiannong, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
- Johansen, Kirsten L., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
Background
Optimizing initiation of dialysis is a goal of the U.S. government. The recently revised Medical Evidence Form (CMS 2728) contains new questions about patients’ understanding of English language health information.
Methods
We used ESRD Quality Reporting system data from Oct. 1, 2024 to March 31, 2025. Inability to understand health literature in English was the exposure. Outcomes were negative responses to questions about being informed of about options for (1) home dialysis, (2) kidney transplantation, and (3) conservative care, plus (4) not receiving home dialysis as incident modality, (5) not using a permanent access upon HD initiation, and (6) not having a living will. We modeled associations using logistic regression, adjusting for age, sex, race/ethnicity, insurance, and duration of pre-dialysis nephrology care.
Results
Inability to understand health literature in English was associated with higher odds of NOT being informed about options for home dialysis (OR 1.62; 95% CIs,1.48-1.78), transplantation (1.54, 1.41-1.69), and conservative care (1.65, 1.50-1.83), plus not receiving home dialysis when initiating (1.34, 1.21-1.48) and not having a living will (1.54, 1.39-1.70). There was no association with lack of a permanent dialysis access at HD initiation (1.02, 0.92-1.13) (Figure). There were significant race/ethnicity-by-outcome interactions for being informed about options for home dialysis, transplantation, and conservative care (p<0.001 for each), with Black and Native Hawaiian/Pacific Islander individuals who do not understand English particularly unlikely to have reported being informed of key treatment options.
Conclusion
Not understanding health literature in English is associated with higher likelihood of nonoptimal initiation of maintenance dialysis.
Funding
- NIDDK Support