Health literacy: emerging evidence and applications in kidney disease care.

Health literacy represents the communication among patients, their social networks, providers, and health systems to promote patients' understanding and engagement in their care. This is particularly relevant in kidney disease, in which the complexity of the medical condition and the extent of the health-care team require strategies to overcome health-literacy-related barriers. Limited literacy is common in patients with all stages of kidney disease and is associated with important outcomes, including reduced knowledge, less adherence, hospitalization, and death. A growing understanding and characterization of the health system, or organizational health literacy, may further our understanding of this dynamic relationship. Although various valid methods exist, assessment of health literacy within individuals or systematically within care settings has not been routinely performed. This may be in part due to the limited research in kidney-specific strategies to address limited health literacy. Future research to understand the mechanisms of health literacy will permit targeted, efficient interventions to bridge gaps and improve outcomes even in patients with complex kidney disease.