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.

2 Internal Clinic Faculty of Medicine P J Safarik University Trieda SNP 1 040 11 Kosice Slovakia

Department of Community and Occupational Health University Medical Center Groningen University of Groningen Antonius Deusinglaan 1 9713 AV Groningen The Netherlands

Department of Health Psychology Faculty of Medicine PJ Safarik University Trieda SNP 1 040 11 Kosice Slovakia

FMC Dialysis Services Slovakia Trieda SNP 1 040 11 Kosice Slovakia

Graduate School Kosice Institute for Society and Health PJ Safarik University Trieda SNP 1 040 11 Kosice Slovakia

Institute of Mathematics Faculty of Science P J Safarik University Jesenna 5 040 01 Kosice Slovakia

Olomouc University Social Health Institute Palacky University in Olomouc Univerzitni 22 Olomouc 771 11 Czech Republic

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Coresh J., Astor B.C., Greene T., Eknoyan G., Levey A.S. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am. J. Kidney Dis. 2003;41:1–12. doi: 10.1053/ajkd.2003.50007. PubMed DOI

Hill N.R., Fatoba S.T., Oke J.L., Hirst J.A., O’Callaghan C.A., Lasserson D.S., Hobbs F.D. Global Prevalence of Chronic Kidney Disease—A Systematic Review and Meta-Analysis. PLoS ONE. 2016;11:e0158765. doi: 10.1371/journal.pone.0158765. PubMed DOI PMC

Jha V., Garcia-Garcia G., Iseki K., Li Z., Naicker S., Plattner B., Saran R., Wang A.Y., Yang C.W. Chronic kidney disease: Global dimension and perspectives. Lancet. 2013;382:260–272. doi: 10.1016/S0140-6736(13)60687-X. PubMed DOI

Levey A.S., Atkins R., Coresh J., Cohen E.P., Collins A.J., Eckardt K.U., Nahas M.E., Jaber B.L., Jadoul M., Levin A., et al. Chronic kidney disease as a global public health problem: Approaches and initiatives—A position statement from Kidney Disease Improving Global Outcomes. Kidney Int. 2007;72:247–259. doi: 10.1038/sj.ki.5002343. PubMed DOI

GBD 2015 Mortality and Causes of Death Collaborators Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1459–1544. doi: 10.1016/S0140-6736(16)31012-1. PubMed DOI PMC

Anderson S., Halter J.B., Hazzard W.R., Himmelfarb J., Horne F.M., Kaysen G.A., Kusek J.W., Nayfield S.G., Schmader K., Tian Y., et al. Prediction, progression, and outcomes of chronic kidney disease in older adults. J. Am. Soc. Nephrol. 2009;20:1199–1209. doi: 10.1681/ASN.2008080860. PubMed DOI

Ash S., Campbell K.L., Bogard J., Millichamp A. Nutrition prescription to achieve positive outcomes in chronic kidney disease: A systematic review. Nutrients. 2014;6:416–451. doi: 10.3390/nu6010416. PubMed DOI PMC

Kang S.S., Chang J.W., Park Y. Nutritional Status Predicts 10-Year Mortality in Patients with End-Stage Renal Disease on Hemodialysis. Nutrients. 2017;9:399. doi: 10.3390/nu9040399. PubMed DOI PMC

Rand C.S. Measuring adherence with therapy for chronic diseases: Implications for the treatment of heterozygous familial hypercholesterolemia. Am. J. Cardiol. 1993;72:68D–74D. doi: 10.1016/0002-9149(93)90014-4. PubMed DOI

Lambert K., Mullan J., Mansfield K. An integrative review of the methodology and findings regarding dietary adherence in end stage kidney disease. BMC Nephrol. 2017;18:318. doi: 10.1186/s12882-017-0734-z. PubMed DOI PMC

Beerappa H., Chandrababu R. Adherence to dietary and fluid restrictions among patients undergoing hemodialysis: An observational study. Clin. Epidemiol. Glob. Health. 2019;7:127–130. doi: 10.1016/j.cegh.2018.05.003. DOI

Saran R., Bragg-Gresham J.L., Rayner H.C., Goodkin D.A., Keen M.L., Van Dijk P.C., Kurokawa K., Piera L., Saito A., Fukuhara S., et al. Nonadherence in hemodialysis: Associations with mortality, hospitalization, and practice patterns in the DOPPS. Kidney Int. 2003;64:254–262. doi: 10.1046/j.1523-1755.2003.00064.x. PubMed DOI

Zoccali C., Moissl U., Chazot C., Mallamaci F., Tripepi G., Arkossy O., Wabel P., Stuard S. Chronic Fluid Overload and Mortality in ESRD. J. Am. Soc. Nephrol. 2017;28:2491–2497. doi: 10.1681/ASN.2016121341. PubMed DOI PMC

Tentori F., Blayney M.J., Albert J.M., Gillespie B.W., Kerr P.G., Bommer J., Young E.W., Akizawa T., Akiba T., Pisoni R.L., et al. Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: The Dialysis Outcomes and Practice Patterns Study (DOPPS) Am. J. Kidney Dis. 2008;52:519–530. doi: 10.1053/j.ajkd.2008.03.020. PubMed DOI

Wizemann V., Wabel P., Chamney P., Zaluska W., Moissl U., Rode C., Malecka-Masalska T., Marcelli D. The mortality risk of overhydration in haemodialysis patients. Nephrol. Dial. Transplant. 2009;24:1574–1579. doi: 10.1093/ndt/gfn707. PubMed DOI PMC

Lambert K., Mansfield K., Mullan J. How do patients and carers make sense of renal dietary advice? A qualitative exploration. J. Ren. Care. 2018;44:238–250. doi: 10.1111/jorc.12260. PubMed DOI

Hollingdale R., Sutton D., Hart K. Facilitating dietary change in renal disease: Investigating patients’ perspectives. J. Ren. Care. 2008;34:136–142. doi: 10.1111/j.1755-6686.2008.00034.x. PubMed DOI

Palmer S.C., Hanson C.S., Craig J.C., Strippoli G.F., Ruospo M., Campbell K., Johnson D.W., Tong A. Dietary and fluid restrictions in CKD: A thematic synthesis of patient views from qualitative studies. Am. J. Kidney Dis. 2015;65:559–573. doi: 10.1053/j.ajkd.2014.09.012. PubMed DOI

Mellon L., Regan D., Curtis R. Factors influencing adherence among Irish haemodialysis patients. Patient Educ. Couns. 2013;92:88–93. doi: 10.1016/j.pec.2013.01.023. PubMed DOI

Dageforde L.A., Cavanaugh K.L. Health literacy: Emerging evidence and applications in kidney disease care. Adv. Chronic Kidney Dis. 2013;20:311–319. doi: 10.1053/j.ackd.2013.04.005. PubMed DOI PMC

World Health Organization Health Promotion Glossary. Health Promot. Int. 1998;134:349–364.

Taylor D.M., Fraser S.D.S., Bradley J.A., Bradley C., Draper H., Metcalfe W., Oniscu G.C., Tomson C.R.V., Ravanan R., Roderick P.J., et al. A Systematic Review of the Prevalence and Associations of Limited Health Literacy in CKD. Clin. J. Am. Soc. Nephrol. 2017;12:1070–1084. doi: 10.2215/CJN.12921216. PubMed DOI PMC

Green J.A., Mor M.K., Shields A.M., Sevick M.A., Palevsky P.M., Fine M.J., Arnold R.M., Weisbord S.D. Prevalence and demographic and clinical associations of health literacy in patients on maintenance hemodialysis. Clin. J. Am. Soc. Nephrol. 2011;6:1354–1360. doi: 10.2215/CJN.09761110. PubMed DOI PMC

Cavanaugh K.L., Wingard R.L., Hakim R.M., Eden S., Shintani A., Wallston K.A., Huizinga M.M., Elasy T.A., Rothman R.L., Ikizler T.A. Low health literacy associates with increased mortality in ESRD. J. Am. Soc. Nephrol. 2010;21:1979–1985. doi: 10.1681/ASN.2009111163. PubMed DOI PMC

Taylor D.M., Fraser S., Dudley C., Oniscu G.C., Tomson C., Ravanan R., Roderick P., ATTOM investigators Health literacy and patient outcomes in chronic kidney disease: A systematic review. Nephrol. Dial. Transplant. 2018;33:1545–1558. PubMed

Grubbs V., Gregorich S.E., Perez-Stable E.J., Hsu C.Y. Health literacy and access to kidney transplantation. Clin. J. Am. Soc. Nephrol. 2009;4:195–200. doi: 10.2215/CJN.03290708. PubMed DOI PMC

Fraser S.D., Roderick P.J., Casey M., Taal M.W., Yuen H.M., Nutbeam D. Prevalence and associations of limited health literacy in chronic kidney disease: A systematic review. Nephrol. Dial. Transplant. 2013;28:129–137. doi: 10.1093/ndt/gfs371. PubMed DOI

Green J.A., Mor M.K., Shields A.M., Sevick M.A., Arnold R.M., Palevsky P.M., Fine M.J., Weisbord S.D. Associations of health literacy with dialysis adherence and health resource utilization in patients receiving maintenance hemodialysis. Am. J. Kidney Dis. 2013;62:73–80. doi: 10.1053/j.ajkd.2012.12.014. PubMed DOI

Tohme F., Mor M.K., Pena-Polanco J., Green J.A., Fine M.J., Palevsky P.M., Weisbord S.D. Predictors and outcomes of non-adherence in patients receiving maintenance hemodialysis. Int. Urol. Nephrol. 2017;49:1471–1479. doi: 10.1007/s11255-017-1600-4. PubMed DOI PMC

Marcelli D., Kirchgessner J., Amato C., Steil H., Mitteregger A., Moscardò V., Carioni C., Orlandini G., Gatti E. EuCliD (European Clinical Database): A database comparing different realities. J. Nephrol. 2001;14:94–100. PubMed

KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. Suppl. 2013;3:1–150. PubMed

Kolarcik P., Cepova E., Madarasova Geckova A., Elsworth G.R., Batterham R.W., Osborne R.H. Structural properties and psychometric improvements of the Health Literacy Questionnaire in a Slovak population. Int. J. Public Health. 2017;62:591–604. doi: 10.1007/s00038-017-0945-x. PubMed DOI

Osborne R.H., Batterham R.W., Elsworth G.R., Hawkins M., Buchbinder R. The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ) BMC Public Health. 2013;13:658. doi: 10.1186/1471-2458-13-658. PubMed DOI PMC

Dempster A.P., Laird N.M., Rubin D.B. Maximum Likelihood from Incomplete Data via the EM Algorithm. J. R. Stat. Soc. Ser. B. 1997;39:1–38. doi: 10.1111/j.2517-6161.1977.tb01600.x. DOI

Beauchamp A., Buchbinder R., Dodson S., Batterham R.W., Elsworth G.R., McPhee C., Sparkes L., Hawkins M., Osborne R.H. Distribution of health literacy strengths and weaknesses across socio-demographic groups: A cross-sectional survey using the Health Literacy Questionnaire (HLQ) BMC Public Health. 2015;15:678. doi: 10.1186/s12889-015-2056-z. PubMed DOI PMC

Adler N.E., Epel E.S., Castellazzo G., Ickovics J.R. Relationship of subjective and objective social status with psychological and physiological functioning: Preliminary data in healthy white women. Health Psychol. 2000;19:586–592. doi: 10.1037/0278-6133.19.6.586. PubMed DOI

Demakakos P., Nazroo J., Breeze E., Marmot M. Socioeconomic status and health: The role of subjective social status. Soc. Sci. Med. 2008;67:330–340. doi: 10.1016/j.socscimed.2008.03.038. PubMed DOI PMC

Zou H., Chen Y., Fang W., Zhang Y., Fan X. The mediation effect of health literacy between subjective social status and depressive symptoms in patients with heart failure. J. Psychosom Res. 2016;91:33–39. doi: 10.1016/j.jpsychores.2016.10.006. PubMed DOI

Ranstam J. Multiple P-values and Bonferroni correction. Osteoarthritis Cartilage. 2016;24:763–764. doi: 10.1016/j.joca.2016.01.008. PubMed DOI

IBM Corp. IBM SPSS Statistics for Windows, Version 23.0. IBM Corp.; Armonk, NY, USA: 2015.

Jain S., Fernando K., Hoover D.R. Health literacy skills of chronic hemodialysis patients. J. Am. Soc. Nephrol. 2005;16:288A.

Dodson S., Osicka T., Huang L., McMahon L.P., Roberts M.A. Multifaceted Assessment of Health Literacy in People Receiving Dialysis: Associations With Psychological Stress and Quality of Life. J. Health Commun. 2016;21:91–98. doi: 10.1080/10810730.2016.1179370. PubMed DOI

Stomer U., Goransson L., Wahl A., Urstad K. Health literacy in patients with chronic kidney disease stages 3–5. Nephrol. Dial. Transplant. 2019;33:i612. doi: 10.1093/ndt/gfy104.SP786. DOI

Batterham R.W., Hawkins M., Collins P.A., Buchbinder R., Osborne R.H. Health literacy: Applying current concepts to improve health services and reduce health inequalities. Public Health. 2016;132:3–12. doi: 10.1016/j.puhe.2016.01.001. PubMed DOI

Jessup R.L., Osborne R.H., Beauchamp A., Bourne A., Buchbinder R. Health literacy of recently hospitalised patients: A cross-sectional survey using the Health Literacy Questionnaire (HLQ) BMC Health Serv. Res. 2017;17:52. doi: 10.1186/s12913-016-1973-6. PubMed DOI PMC

Nutbeam D. Health Literacy as a public health goal: A challenge for contemporary health education and communication strategies info the 21st century. Health Promot. Int. 2000;15:259–267. doi: 10.1093/heapro/15.3.259. DOI

Baker D.W. The meaning and the measure of health literacy. J. Gen. Intern. Med. 2006;21:878–883. doi: 10.1111/j.1525-1497.2006.00540.x. PubMed DOI PMC

Ishikawa H., Yano E. Patient health literacy and participation in the health-care process. Health Expect. 2008;11:113–122. doi: 10.1111/j.1369-7625.2008.00497.x. PubMed DOI PMC

Rüegg R., Abel T. The relationship between health literacy and health outcomes among male young adults: Exploring confounding effects using decomposition analysis. Int. J. Public Health. 2019;64:535–545. doi: 10.1007/s00038-019-01236-x. PubMed DOI

Does Depression and Anxiety Mediate the Relation between Limited Health Literacy and Diet Non-Adherence?