The Increased Burden of CKD in Young Adults with Questionable Levels of Education and Health Literacy

Document Type

Conference Proceeding

Publication Date

11-1-2023

Publication Title

J Am Soc Nephrol

Abstract

Introduction: This case highlights the harmful effects of unsatisfactory healthcare education that may contribute to poor patient insight in certain communities across the United States. Case Description: This patient is a 29-year-old G4P2113 black female with a past medical history of uncontrolled hypertension(HTN), chronic kidney disease(CKD), and morbid obesity. Her health insurance is managed by Medicaid. At age 17, she had her 1st spontaneous vaginal delivery(SVD) in the emergency department(ED) with no prenatal care(PNC). Urinalysis(UA) during her 3rd trimester was significant for 3+ proteinuria. She was discharged with normal blood pressure(BP). The patient was noncompliant with post-partum follow-up. Her 2nd term SVD was at age 18 with limited PNC(2 ED visits were for severe HTN and proteinuria was noted). BP at discharge was normal but she had proteinuria. In the next 5 years, she lost her 3rd pregnancy. At age 25, she presented for an annual GYN exam where she was diagnosed with HTN and given NifedipineCC. ED visits documented that she had no primary care provider(PCP) and showed CKD stage 3A. A year later, she returned to the ED with uncontrolled HTN to confirm her 4th pregnancy. She had CKD stage 3B with 2+ proteinuria and a GFR of 43mL/min. She was admitted to labor and delivery and had a preterm SVD. When seen post-partum, the patient was in denial about her diagnosis of CKD. She did not comply with a renal diet and refused anti-hypertensives. To date, she does not have a PCP or nephrologist although she was referred and told about the gravity of the diagnosis. Discussion: Many factors contributed to the progression of this patient's illness: individual, interpersonal, societal and institutional factors. This patient lacked insight into the consequences of proteinuria and HTN that progressed to CKD. She had 3 children without family support. Her early pregnancies interfered with her high school education. We believe that her low socioeconomic status(SES) and domicile negatively impacted her access to a healthy diet. Her race, gender and SES predispose her to poorer health outcomes(HO). The effect of her education and health literacy highlights the impact of healthcare on young adults: It must be further studied to provide focused upstream interventions. An education program incorporating health literacy in high school may help prevent adverse HO.

Volume

34

First Page

376

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