Development and Validation of Kidney Replacement Therapy Knowledge (Know-KRT) Instrument.

Introduction: Awareness of kidney replacement therapies (KRT) 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 chronic kidney disease (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 < .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 <.001). KRT awareness was low, with an ease index of 0.181 for the full instrument. The General, Technical, and Correlative domains scores demonstrated strong correlations with the Know-KRT total score (r=0.68, 0.61, and 0.48, respectively, p<.001) and CKD instrument score (r=0.95, 0.93, and 0.77, respectively, P < .001). KRT and CKD awareness correlated negatively with age and positively with health literacy, employment status, hypertension, and quality of nephrology care. Conclusion: We report a newly developed KRT knowledge 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.