The Knowledge Assessment of Renal Transplantation (KART) 2.0 Development and Validation of CKD and Transplant Knowledge Scales

Amy D. Waterman, Devika Nair, Intan Purnajo, Kerri L. Cavanaugh, Brian S. Mittman, John Devin Peipert

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background and objectives Many individuals with kidney disease, particularly those belonging to racial and ethnic minority groups and whose primary language is not English, lack knowledge related to kidney disease symptoms, physiologic functions of the kidney, and benefits and risks of kidney transplantation. Valid instruments to assess patients’ knowledge of CKD and kidney transplantation are needed. Design, setting, participants, & measurements Using a sample of 977 patients with stages 3–5 CKD in the Kaiser Permanente health system, we developed the Knowledge Assessment of Renal Transplantation (KART) 2.0 instrument. We conducted cognitive interviews followed by item response theory (IRT) to reduce 48 candidate items. Construct validity was tested by examining differences in scores between patients who spent,1 and $1 hour receiving CKD and transplant education. Results Cognitive interviews modified four items and omitted 11. IRT analyses resulted in two scales: the KART 2.0–Transplant Knowledge Scale (16 items; Cronbach’s a50.8) and the KART 2.0–CKD Knowledge Scale (nine items; Cronbach’s a50.79). Differential item functioning showed that the scales were unbiased to capture knowledge across self-identified race, primary language, CKD stage, and sex. Both scales distinguished patients who had spent,1 and $1 hour speaking with health professionals (effect size [ES]50.33 [transplant], 0.54 [CKD]; P,0.001 for both), reading about kidney disease (ES50.45 [transplant], 0.62 [CKD]; P,0.001), reading about kidney transplantation (ES50.67 [transplant], 0.69 [CKD]; P,0.001), and reading about living donor kidney transplant (ES50.76 [transplant], 0.62 [CKD]; P,0.001). Conclusions The KART 2.0 is a valid tool to assess patients’ knowledge of CKD and kidney transplantation.

Original languageEnglish (US)
Pages (from-to)555-564
Number of pages10
JournalClinical Journal of the American Society of Nephrology
Issue number4
StatePublished - Apr 2022


  • CKD
  • education
  • knowledge
  • transplantation
  • transplants
  • Minority Groups
  • Ethnicity
  • Renal Insufficiency, Chronic/diagnosis
  • Kidney Transplantation/psychology
  • Humans
  • Health Knowledge, Attitudes, Practice

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation
  • Epidemiology


Dive into the research topics of 'The Knowledge Assessment of Renal Transplantation (KART) 2.0 Development and Validation of CKD and Transplant Knowledge Scales'. Together they form a unique fingerprint.

Cite this