Abstract: TH-PO522

Food Insecurity and Longitudinal Risk of Rapid Kidney Function Decline

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 307 CKD: Health Services, Disparities, Prevention

Authors

  • Crews, Deidra C., Johns Hopkins University , Baltimore, Maryland, United States
  • Kwon, Caroline, None, Washington, District of Columbia, United States
  • Han, Dingfen, Johns Hopkins University, Baltimore, Maryland, United States
  • Liu, Yang, Johns Hopkins University , Baltimore, Maryland, United States
  • Banerjee, Tanushree, University of CA, San Francisco, San Francisco, California, United States
  • Evans, Michele Kim, National Institutes of Health/National Institute on Aging, Baltimore, Maryland, United States
  • Zonderman, Alan B., Intramural Research Program, NIA, NIH, Baltimore, Maryland, United States
  • Powe, Neil R., Priscilla Chan & Mark Zuckerberg San Francisco General Hospital & University of California SF, San Francisco, California, United States
  • Kuczmarski, Marie, University of Delaware, Newark, Delaware, United States
Background

Food insecurity, defined as limited or uncertain ability to acquire food, has been associated with prevalent CKD and CKD progression to ESRD. Whether food insecurity is associated with loss of kidney function among persons with preserved kidney function is not known.

Methods

We conducted a longitudinal analysis of the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) Study (Baltimore MD) to determine whether food insecurity was associated with rapid kidney function decline (KFD). Participants with eGFR≧60 ml/min per 1.73m2 were included (n=1471). Food insecurity was defined as an affirmative response to, ‘In the last 12 months, did you or your household ever cut the size of your meals or skip meals because there wasn’t enough money for food?’ KFD was defined over an average of 5-years' follow-up as: follow-up eGFR decreased by more than 3% per yr from baseline; or full follow-up eGFR decreased by more than 25%. Multivariable logistic regression models assessed the relation of food insecurity and KFD.

Results

At baseline, 24.8% of participants were food insecure. These persons were younger, more likely to be female, African American, living in poverty, with fewer yrs of education, uninsured and current smokers than were food secure persons (p<0.05 for all). Food insecure persons had lower Healthy Eating Index (HEI) 2010 scores and were more likely to be obese, but equally as likely to have diabetes and hypertension as food secure persons. Overall,13.3% had >3% per yr eGFR decline, while 4.2% had ≥25% eGFR decline over full follow-up. Food insecurity was not associated with >3% per yr eGFR decline, but was associated with ≥25% eGFR decline (Table). Clinical factors explained little of this association. Among 1,164 participants with HEI data, the magnitude of the association of food insecurity with ≥25% eGFR decline was similar, though not statistically significant (1.87, 95% CI 0.9, 3.9).

Conclusion

For persons free of CKD, food insecurity may be a risk factor for rapid loss of kidney function over time.

Association of Food Insecurity (vs. Security) and Rapid Kidney Function Decline
Model>3% eGFR decline per year
Odds Ratio (95% CI)
≧25% eGFR decline over full follow up
Odds Ratio (95% CI)
1-Unadjusted1.18 (0.78, 1.79)1.84 (1.11, 3.06)
2-Adjusted for age, race, sex, poverty status and baseline eGFR1.13 (0.72, 1.79)1.86 (1.05, 3.29)
3-Adjusted for age, race, sex, poverty status, baseline eGFR, diabetes, hypertension and obesity1.10 (0.66, 1.84)1.83 (0.94, 3.58)

Funding

  • NIDDK Support