Limited health literacy is associated with low glomerular filtration in the chronic renal insufficiency cohort (cric) study

Ana C. Ricardo*, Wei Yang, Claudia M. Lora, Elisa J. Gordon, Clarissa J. Diamantidis, Virginia Ford, John W. Kusek, Amada Lopez, Eva Lustigova, Lisa Nessel, Sylvia E. Rosas, Susan Steigerwalt, Jacqueline Theurer, Xiaoming Zhang, Michael J. Fischer, James P. Lash

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

58 Scopus citations


Background: Low health literacy in the general population is associated with increased risk of death and hospitalization. The evaluation of health literacy in individuals with predialysis chronic kidney disease (CKD) is limited. Methods: We conducted a cross-sectional study to evaluate the associations of limited health literacy with kidney function and cardiovascular disease (CVD) risk factors in 2,340 non-Hispanic (NH) Whites and Blacks aged 21-74 years with mild-to-moderate CKD. Limited health literacy was defined as a Short Test of Functional Health Literacy in Adults (STOFHLA) score = 22. Outcomes evaluated included estimated glomerular filtration rate (eGFR), 24-hour urine protein excretion, and CVD risk factors. Results: The prevalence of limited health literacy was 28% in NH-Blacks and 5% in NH-Whites. Compared with participants with adequate health literacy, those with limited health literacy were more likely to have lower eGFR (34 vs. 42 mL/min/1.73 m2); higher urine protein/24-hours (0.31 vs. 0.15 g); and higher self-reported CVD (61 vs. 37%); and were less likely to have BP < 130/80 mmHg (51 vs. 58%); p = 0.01 for each comparison. After adjustment, limited health literacy was associated with self-reported CVD (OR 1.51, 95% CI 1.13-2.03) and lower eGFR (β -2.47, p = 0.03). Conclusion: In this CKD cohort, limited health literacy was highly prevalent, especially among NH-Blacks, and it was associated with lower eGFR and a less favorable CVD risk factor profile. Further studies are needed to better understand these associations and inform the development of health literacy interventions among individuals with CKD.

Original languageEnglish (US)
Pages (from-to)30-37
Number of pages8
JournalClinical Nephrology
Issue number1
StatePublished - Jan 2014


  • Chronic kidney disease
  • Health literacy

ASJC Scopus subject areas

  • Nephrology


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