Understanding of Key Facts Relevant to Dialysis Care Among Patients Undergoing Hemodialysis

INTRODUCTION: Patients with end-stage renal disease who are on hemodialysis (HD) experience high rates of hospitalization and fragmentation in care, which is associated with poor health outcomes and high health care costs. This study characterizes patients' awareness and understanding of the delivery of HD, which can serve as a predictive measure of the care they receive. METHODS: This prospective cross-sectional survey study included 100 participants who were recruited from the inpatient dialysis unit of a single institution that dialyzes acutely hospitalized patients. Patients who had been diagnosed with end-stage renal disease and were on maintenance HD were eligible for the study. Patient awareness and understanding of dialysis care were assessed by a structured questionnaire and verified against the electronic health record. RESULTS: On average, the 100 participants answered 2.98 of 5 items correctly (59.6%). Lower educational attainment (high school or less vs college or greater) was associated with a reduced probability of correctly identifying one's own dry weight (odds ratio [OR], 0.18; 95% confidence interval [CI], 0.03-0.75) and primary outpatient nephrologist (OR, 0.26; 95% CI, 0.07-0.97). A primary language other than English predicted a lower probability of correctly identifying dialysis facility (OR, 0.14; 95% CI, 0.02-0.83). DISCUSSION: Among hospitalized patients with end-stage renal disease receiving acute, inpatient-based dialysis, few participants answered all of the questions about dialysis care correctly, and education level, sex, race, and primary language were associated with specific domains of awareness and understanding gaps. CONCLUSIONS: These findings highlight actionable targets for improving awareness and understanding of care and support broader efforts to improve information transfer and patient engagement to enhance continuity and safety of dialysis care.