title: Patient dialysis knowledge is associated with permanent arteriovenous access use in chronic hemodialysis.
abstract: OBJECTIVE
  Patient knowledge about chronic hemodialysis (CHD) is important for effective self-management behaviors, but little is known about its association with vascular access use.
  
  
  METHODS
  Prospective cohort of adult incident CHD patients from May 2002 until November 2005 and followed for 6 mo after initiation of hemodialysis (HD). Patient knowledge was measured using the Chronic Hemodialysis Knowledge Survey (CHeKS). The primary outcome was dialysis access type at: baseline, 3 mo, and 6 mo after HD initiation. Secondary outcomes included anemia, nutritional, and mineral laboratory measures.
  
  
  RESULTS
  In 490 patients, the median (interquartile range) CHeKS score (0 to 100%) was 65%[52% to 78%]. Lower scores were associated with older age, fewer years of education, and nonwhite race. Patients with CHeKS scores 20 percentage points higher were more likely to use an arteriovenous fistula or graft compared with a catheter at HD initiation and 6 mo after adjustment for age, sex, race, education, and diabetes mellitus. No statistically significant associations were found between knowledge and laboratory outcome measures, except for a moderate association with serum albumin. Potential limitations include residual confounding and an underpowered study to determine associations with some clinical measures.
  
  
  CONCLUSIONS
  Patients with less dialysis knowledge may be less likely to use an arteriovenous access for dialysis at initiation and after starting hemodialysis. Additional studies are needed to explore the impact of patient dialysis knowledge, and its improvement after educational interventions, on vascular access in hemodialysis.
authors.affiliation: Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2372, USA. kerri.cavanaugh@vanderbilt.edu
authors.forename: Kerri L
authors.initials: KL
authors.lastname: Cavanaugh
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Wingard
authors.forename: Raymond M
authors.initials: RM
authors.lastname: Hakim
authors.forename: Tom A
authors.initials: TA
authors.lastname: Elasy
authors.forename: T Alp
authors.initials: TA
authors.lastname: Ikizler
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011446:Prospective Studies; D006435:Renal Dialysis / Q000523:psychology*