Speak to Me in English, Doc

Researchers double patients' basic CKD knowledge.

A common frustration of many nephrologists and kidney caregivers is the lack of knowledge patients have about their own condition.

It's a phenomenon that Kerri Cavanaugh, MD, of Vanderbilt University Medical Center, has spent a good deal of time studying and trying to combat.

"Our previous work has shown that there are substantial kidney knowledge gaps, even in patients actively seeing a nephrologist," said Dr. Cavanaugh. "Sometimes they have difficulty understanding their own disease status and general information about kidney health as well."

Research has shown that low patient kidney knowledge has been associated with less use of permanent dialysis access, shorter times to dialysis therapy initiation and increased mortality and hospitalizations. A lack of understanding may also impede decision making in many areas critical to preventing kidney disease progression and in preparing for kidney failure or transplantation.

In an attempt to better patient knowledge, Dr. Cavanaugh and her team developed a kidney education program to be delivered by a physician or nephrologist during regular patient visits. After a 1-2 minute informational intervention, the patient would then leave their appointment with an individualized, one-page, front-and-back card that summarized their condition. The card is based on materials from the National Kidney Disease Education Program.

"There have been a variety of educational intervention programs over the years in nephrology. Often, however, they have a variety of components and it is difficult to isolate the effect of any of its individual parts," Dr. Cavanaugh said. "Here, we aimed to keep it simple, low resource, easy to integrate and implement…Interventions like this seem obvious, but in reality I think it is challenging to do well in the constraints of the medical system overall."

The intervention cohort receiving the educational materials included 155 CKD patients who were at least 18 years old and had seen a nephrologist at least once. They were followed in nine nephrology clinics by nine attending physicians and 16 nephrology fellows.

After administering the worksheet, those in the intervention group were more than two times as likely to know their CKD diagnosis and were similarly more aware of their current estimated kidney function compared to a baseline historical group adjusted for age, sex, race, health literacy and other variables.

"While this is a good sign that use of the worksheet may increase patient's understanding of their kidney health, more rigorous studies need to be done to make more conclusive statements about its impact," Dr. Cavanaugh said. "However, these preliminary results show that this type of model may be useful, especially in primary care and nephrology settings."

Dr. Cavanaugh and the researchers who developed and tracked the education project have made their worksheet available as part of their published abstract in the July issue of the National Kidney Foundation's American Journal of Kidney Disease. The original NKDEP worksheet that was modified for this research can be obtained .

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