Health Literacy and Treatment Compliance Among Patients with Chronic Kidney Disease Attending a Nephrology Outpatient Department and Dialysis Center in Lahore, Pakistan: An Analytical Cross-Sectional Study
Sana Atta Muhammada, Javeria Sher Alib, Tania Amjadc
- aRiphah International University, Lahore, Pakistan
- bQuetta Institute of Medical Sciences, Quetta, Pakistan
- cUniversity of South Asia, Lahore, Pakistan
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Abstract
Background: Chronic kidney disease (CKD) requires long-term adherence to medications, dietary and fluid restrictions, clinical monitoring, and, in advanced disease, regular hemodialysis. Health literacy may influence patients’ ability to understand and apply treatment recommendations. Objective: To determine health-literacy levels and treatment compliance among patients with CKD and assess associations with medication adherence and dialysis-related compliance. Methods: This analytical cross-sectional study included 125 adults with CKD attending nephrology outpatient and hemodialysis services at Riphah International University, Lahore, Pakistan, from November 2025 to March 2026. Health literacy was assessed using HLS-EU-Q16 and medication adherence using MMAS-8. Dialysis-specific measures included missed hemodialysis sessions, diet/fluid non-adherence, and serum phosphate. Data were analysed using IBM SPSS Statistics version 26.0 with descriptive, correlation, chi-square, Kruskal-Wallis, and logistic-regression analyses. Results: Mean age was 60.86±11.10 years; 62.4% received predialysis care and 37.6% underwent hemodialysis. Low, mid-level, and high health literacy were observed in 26.4%, 53.6%, and 20.0%, respectively, while 57.6% had low medication adherence. HLS-EU-Q16 correlated positively with MMAS-8 (ρ=0.413, p<0.001). Medication non-adherence occurred in 81.8% of patients with low literacy compared with 49.3% and 48.0% with mid-level and high literacy (p=0.005). Higher health literacy independently predicted lower medication non-adherence (aOR=0.66, 95% CI 0.52–0.83; p<0.001) and fewer missed dialysis sessions (ρ=−0.306, p=0.036). Conclusion: Limited health literacy was significantly associated with poorer treatment compliance in CKD. Keywords: Chronic Kidney Disease; Health Literacy; Medication Adherence; Hemodialysis; Pakistan.
TL;DRLimited health literacy was significantly associated with poorer treatment compliance in CKD and associations with medication adherence and dialysis-related compliance were assessed. (Semantic Scholar)