*Purpose: While consensus exists on the need to educate patients earlier about transplant, delays in education persist, leaving patients insufficient time to make optimal renal replacement (RRT) decisions. This study assessed levels of transplant-related knowledge and actions by kidney patients varying by CKD stage and primary language spoken.

*Methods: 971 patients at Kaiser Permanente Southern California were assessed about their knowledge of CKD symptoms (6-items, e.g., increased fatigue is a CKD symptom) and transplant (20-items, e.g., patients can live longer with a transplant than on dialysis). They also reported whether they had already taken 25 possible RRT actions divided into three groups: (1) learning actions, (2) making informed decisions about RRT, and (3) pursuing transplant. Patients varied by CKD Stage [3 (41.2%); 4 (34.4%); 5 (24.4%)], race/ethnicity, and primary language [Spanish-speaking Hispanic (28%), White (22%), English-speaking Hispanic (22%), Black (18%), and Asian (10%)].

*Results: Overall, patients correctly answered 58% of CKD symptoms items, and 20% of transplant knowledge items. Most patients had taken few steps to learn more (median: 0 of 5 steps), make informed decisions about RRT options (median: 2 of 6 steps), and pursue transplant (median: 0 of 6 steps). Earlier CKD stage and Spanish-speaking patients had poorer CKD symptom and transplant knowledge and took fewer action steps overall (Table).

*Conclusions: Patients in earlier CKD stages and Spanish-speakers are less knowledgeable and less likely to take transplant-related actions, however, all patients need greater support with RRT decision-making and pursuit of transplant. Educational interventions that engage patients earlier in their CKD progression may increase informed decision-making and pursuit of LDKT.

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