Health-related quality of life (HRQoL) is likely to deteriorate with the progression of chronic kidney disease (CKD). This change may be worsened by low health literacy (HL). We performed a longitudinal study at over 20 dialysis clinics in Slovakia (n = 413; mean age = 64.8 years; males = 58.4%). We assessed the association of three HL groups with a change in HRQoL over two years using binary logistic regression adjusted for type of vascular access, dialysis effectiveness, comorbidity, age and gender. We found that patients with low HL had poorer HRQoL at baseline in comparison to high-HL patients. We did not find significant associations of lower HL with the deterioration of mental or physical HRQoL after two years. In the adjusted model, patients with lower HL were not more likely to have deteriorated physical (low-HL patients: odds ratio/95% confidence interval: 0.99/0.53-1.84; moderate-HL patients: 0.97/0.55-1.73) or mental HRQoL (low-HL patients: 1.00/0.53-1.87; moderate-HL patients: 0.95/0.53-1.70) in comparison to high-HL patients. The HRQoL of lower-HL patients is worse at baseline but develops similarly to that of high-HL patients during dialysis treatment. Their relative HRQoL, thus, does not worsen further, but it does not improve either. Tailoring care to their needs may help to decrease the burden of low HL in dialysed patients.

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

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

Department of Health Psychology and Research Methodology Faculty of Medicine P J 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 Faculty of Medicine P J Safarik University Trieda SNP 1 040 11 Kosice Slovakia

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

Olomouc University Social Health Institute Palacky University Univerzitní 22 771 47 Olomouc Czech Republic

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