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Abstract: SA-PO1043

Prevalence and Impact of Food Insecurity in Children with ESRD

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1302 Health Maintenance, Nutrition, and Metabolism: Clinical

Authors

  • Starr, Michelle C., Seattle Children's Hospital, Seattle, Washington, United States
  • Wightman, Aaron G., Seattle Children's Hospital, Seattle, Washington, United States
  • Munshi, Raj P., Seattle Children's Hospital, Seattle, Washington, United States
  • Hingorani, Sangeeta R., Seattle Children's Hospital, Seattle, Washington, United States
Background

Food insecurity (FI) affects 1 in 6 children in America. Children with kidney disease, especially those with End-Stage Renal Disease (ESRD) may be at higher risk, due to their complex care needs, medication burden, and dietary restrictions. Adults with kidney disease and FI progress more quickly to ESRD. The prevalence and impact of FI in pediatric ESRD patients is largely unknown. We sought to determine the prevalence of FI among children with ESRD receiving dialysis and to examine the relationship between FI and clinical factors, healthcare utilization, and quality of life.

Methods

We assessed food insecurity among families of dialysis patients age <21 years seen for ESRD at an academic pediatric center. The primary predictor was household FI status, determined using the Hunger Vital sign, a validated 2 question-screening tool. We compared demographic features, clinical factors, and outcomes including health care utilization between families identified as FI versus those not. We defined unplanned healthcare utilization as unscheduled admission to the hospital, Emergency Department visit, or dialysis related infection.

Results

A total of 43 families were enrolled in this study; 24 (55%) were on peritoneal dialysis (PD) and 19 (45%) were on hemodialysis (HD). 27 of 43 (65%) of children with ESRD lived in food insecure households, with a larger percentage of children on HD reporting FI compared to those on PD (73.7 vs. 54.2%). Food insecure children were more likely to have an unplanned healthcare utilization event (96.3 vs. 75.0%, p = 0.035), including hospitalization (p=0.008) and intensive care unit admissions (p=0.03). Children with FI had a trend towards more dialysis related infections (48.1 vs. 25.0%). Clinically, children with FI were less likely to have adequate Kt/V for the last 3 months (63.0 vs. 93.4%, p=0.03). Both child and parent proxy quality of life scores tended to be lower in those with FI on all subscales, particularly the worry subscale.

Conclusion

FI is common among children on dialysis therapy and negatively impacts clinical care, healthcare utilization, and quality of life. Further exploration into how FI and other social determinants of health influence management of and impact outcomes for children with ESRD is warranted as are interventions to decrease rates of FI.

Funding

  • NIDDK Support