35 METHODS We performed this systematic review in line with the principles of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)[25]. SEARCH STRATEGY AND ELIGIBILITY Two reviewers (MDB, EFM) developed the search strategy and eligibility criteria with the support of two database search experts from the University Medical Center Groningen. After a pilot search to determine sensitivity and specificity, and discussion with a third reviewer (AFW), the strategy was finalized. The search strategy aimed to retrieve original English, French or German peer-reviewed quantitative, qualitative and intervention studies related to HL and CKD. The final search strategy included a combination of CKD-specific terms, such as ‘chronic kidney’ or ‘dialysis’ and ‘renal transplant’, and HL related terms, such as ‘literacy’ and ‘numeracy’. Details on the search strategy are in Supplemental Tables 1a-1c. Studies were eligible for inclusion if they: 1) included (a cohort of) any stage CKD patients ≥18 and/or health care professionals, 2) assessed HL using a validated screener or questionnaire, 3) gave results on associations of LHL with potential mediating factors, derived from the Pathway of Paasche-Orlow, or 4) provided information on the development and testing of interventions, customized to CKD and the needs of LHL patients. We excluded studies that: 1) used educational level as a measure of HL, 2) focused solely on associations of HL with knowledge or health outcomes, or 3) developed or validated HL screeners. Further information about the in- and exclusion criteria is in Supplemental Table 2. STUDY SELECTION Two reviewers (MDB and EMF) performed a systematic database search in Medline, Embase and Web of Science. They used an Excel file with main author, year, and title to guide study selection. Both reviewers read titles and abstracts of all identified unique records to include studies that met the inclusion criteria. Disagreements were solved by discussion. If still uncertain about eligibility, reviewers read the full-text publication and decided based on a new discussion.
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