TOPLINE: 

Overall, 20% of patients attending a vascular access clinic had an unsustainable treatment burden. Poor health literacy was associated with a nearly fourfold increase in the odds of experiencing overwhelming care demands. 

METHODOLOGY:

• Researchers conducted a cross-sectional study to assess health literacy and perceived treatment burden among patients referred to a haemodialysis vascular access surgery clinic in Scotland.
• They included 563 patients with advanced chronic kidney disease (CKD; median age, 64 years; 43% women): 300 with predialysis CKD and 263 already on kidney replacement therapy, all referred for new vascular access creation or evaluation of existing access issues.
• Treatment burden was assessed using the validated 15-item Treatment Burden Questionnaire, covering medication use, medical appointments, administrative and financial burden, and the impact of treatment on daily life; scores ≥ 59 indicated an unsustainable burden.
• Health literacy was evaluated using a single-item health literacy screening questionnaire.
• Data on demographics, socioeconomic status, comorbidities, and travel times to the hospital were also collected.

TAKEAWAY:

• Overall, 20% of patients attending the haemodialysis vascular access clinic had unsustainable levels of treatment burden.
• Medication management, administrative complexity, and financial strain were identified as the main contributors to unsustainable treatment burden in this population; those already on kidney replacement therapy had significantly higher treatment burden scores than those with predialysis CKD (median, 29 vs 25; P = .03).
• Poor health literacy (adjusted odds ratio [aOR], 3.78; P < .001) and increased socioeconomic deprivation (aOR, 1.21; P = .034) were independently associated with increased odds of unsustainable treatment burden.

IN PRACTICE:

"Both treatment burden and health literacy are measurable and potentially modifiable factors that can help identify patients at increased risk of disengagement or nonadherence," the authors wrote.

SOURCE:

This study was led by Ben Edgar, School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, Scotland. It was published online on November 25, 2025, in BMC Nephrology.

LIMITATIONS: 

The cross-sectional design prevented causal inference between risk factors and treatment burden. The single-centre setting and use of English-only questionnaires may have limited generalisability. Additionally, the Treatment Burden Questionnaire, though validated in patients with CKD, was originally developed for multimorbidity and may not fully capture dialysis-specific burden.

DISCLOSURES:

This study received funding from Kidney Research UK. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.