Abstract
KEY POINTS: KRT awareness is important for informed choice and use of dialysis modalities, but we lack validated instruments capable of measuring such awareness. We present a newly developed KRT Knowledge instrument, which can be used to evaluate the kidney failure and KRT awareness among patients with CKD. Our results show that KRT awareness is different and significantly lower than CKD awareness among patients with advanced CKD. BACKGROUND: Awareness of KRTs is associated with greater home dialysis use. However, validated instruments evaluating patient knowledge and awareness of various KRTs are currently lacking and are critical for informed decision making. METHODS: We developed a 24-item KRT knowledge instrument (Know-KRT) encompassing three domains of General, Technical, and Correlative information critical for informed dialysis decision making. We conducted a cross-sectional study among Veterans with advanced CKD to determine its reliability, dimensionality, and validity. RESULTS: The Know-KRT instrument dimensionality was acceptable with a root mean squared error of approximation of 0.095 for the conceptual three-domain model fit (χ(2)=824.6, P < 0.001). Corrected Item-Total Correlation indices were excellent (>0.4) for all individual items. Internal consistency was excellent for the full instrument, Cronbach's alpha, α=0.95, with α=0.86, 0.91, and 0.79 for the General, Technical, and Correlative domains, respectively. The Know-KRT score correlated strongly with the CKD knowledge score (r=0.68, P < 0.001). KRT awareness was low, with an ease index of 0.181 for the full instrument. The General, Technical, and Correlative domain scores demonstrated strong correlations with the Know-KRT total score (r=0.68, 0.61, and 0.48, respectively, P < 0.001) and CKD instrument score (r=0.95, 0.93, and 0.77, respectively, P < 0.001). KRT and CKD awareness correlated negatively with age and positively with health literacy, employment status, hypertension, and quality of nephrology care. CONCLUSIONS: We report a newly developed Know-KRT instrument with three domains having acceptable internal consistency, reliability, and validity. We show that patients with advanced CKD have low awareness of KRTs, even for items related to basic descriptions of modalities, highlighting the need for targeted patient education efforts. CLINICAL TRIAL REGISTRATION NUMBER: NCT04064086.