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Abstract: PO2299

Food Insecurity During COVID-19 in Children with ESKD: The Second Wave?

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology


  • Chan, Melvin, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Wilson, Amy C., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Pottanat, Neha Dhingra, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Starr, Michelle C., Indiana University School of Medicine, Indianapolis, Indiana, United States

Food insecurity (FI) affects 1 in 6 children in the US and has increased three-fold during the COVID pandemic. Children with end-stage kidney disease (ESKD) may be at even higher risk of FI due to complex care needs, medication burden and dietary restrictions. A pre-COVID study assessing FI in pediatric hemodialysis (HD) patients described 70% prevalence. No data exists describing the effects of the COVID pandemic on FI in pediatric HD patients.


We assessed FI among families of patients age 0-18 years with ESKD on chronic HD at a single academic pediatric center. Families were screened for FI by using the Hunger Vital sign, a validated 2 question tool. We assessed impact of COVID on FI. Using demographic features, clinical parameters and medical utilization, we compared “pre-COVID” (2/2020) to “during COVID” (5/2020).


A total of 14 families were enrolled. 12 of 14 (86%) of children with ESKD were FI, and all 12 (100%) reported that COVID had worsened their FI status. The prevalence of FI in our HD unit was five times higher than the general population (86% vs. 15%,p<0.001). Patients with FI had an increase in phosphorus during COVID (5.0 to 5.9 mg/dL,p=0.031). Patients with FI self-described as highly impacted by COVID were more likely to have an increase in serum phosphorus levels during COVID (mean increase of 1.7 vs. 0.1 mg/dL, p=0.017).(Fig 1) No patients with FI highly impacted by COVID had serum phosphorus levels within range compared to those less impacted (0% vs. 38%, p=0.040).


FI is common among children with ESKD on HD and was worsened by the COVID pandemic. The prevalence of FI in COVID was significantly higher than community reported rates and published pre-COVID rates in children with ESKD. FI was associated with increased serum phosphorus levels. Further exploration into how FI during the COVID pandemic influence management and impact outcomes for children with ESRD is essential.

Serum Phosphorus Levels in Children with ESKD and Food Insecurity