Exploring Health Literacy and Vascular Access Decision Making: A Scoping Review

One in seven adults in the United States has chronic kidney disease (CKD) and individuals with the most severe form, end stage kidney disease (ESKD), may require renal replacement therapy with hemodialysis. Despite well-established guidelines indicating that arteriovenous access is the preferred type of vascular access for hemodialysis, in 2021, 85.4% of patients initiated dialysis with a CVC. While the reasons for this evidence-practice gap are unclear, health literacy and patient disease-specific knowledge may play an important role. Importantly, 25% of patients with CKD have limited health literacy. While there is an abundance of research regarding the presence of poor health literacy, poor kidney disease-specific knowledge, and their association with health outcomes in patients with CKD, there is currently a paucity of data about the relationship between health literacy, vascular access-specific knowledge, and vascular access outcomes. The aim of this narrative review is to describe the relationship between health literacy, disease-specific knowledge, and vascular access in patients with CKD. A better understanding of health literacy in this population will help inform the development of strategies to assess patient vascular access-specific knowledge and aid in vascular access decision making.