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Abstract: SA-PO043

Association of Food Insecurity and Treatment Nonadherence or Hospitalization Among Adults on Hemodialysis

Session Information

Category: Diversity and Equity in Kidney Health

  • 900 Diversity and Equity in Kidney Health

Authors

  • Taylor, Kathryn, Johns Hopkins University School of Nursing, Baltimore, Maryland, United States
  • Fisher, Marlena, Johns Hopkins University School of Nursing, Baltimore, Maryland, United States
  • Santos, Sydney, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Chen, Yuling, Johns Hopkins University School of Nursing, Baltimore, Maryland, United States
  • Smith, Owen Woodfield, Johns Hopkins University School of Nursing, Baltimore, Maryland, United States
  • Perrin, Nancy A., Johns Hopkins University School of Nursing, Baltimore, Maryland, United States
  • Crews, Deidra C., The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
Background

Food insecurity is associated with hospitalization among children on hemodialysis, but existing research has not tested associations among adults.

Methods

We conducted a prospective cohort study to test associations between food insecurity and missed treatments or hospitalizations. We enrolled a convenience sample of adults (>=18 years) on hemodialysis (>=3 months) from 17 facilities in Maryland, Washington, D.C., or Virginia from February through November 2021. Participants completed demographics and the US Adult Food Security Survey Module at baseline and remained in the study for 6 months. We collected missed treatment counts and hospital admission and discharge dates (all-cause and fluid or electrolyte-related) from facility records. We created negative binomial regression and Cox models to test associations between food insecurity and missed treatments or hospitalizations, respectively. We repeated hospitalization analyses stratifying by age (<55 or >=55 years) to account for confounding.

Results

We analyzed data from 288 out of 322 participants (89%) who completed surveys. Mean age was 60 years (range 27 – 86 years), 58% of the sample were male, 73% self-identified race as Black. At baseline, 61 participants (21%) reported food insecurity. During follow-up, 138 participants (48%) missed at least one hemodialysis treatment (range 0 – 29 treatments) and 91 participants (32%) were hospitalized (range 0 – 5 hospitalizations). Twenty participants (7%) were hospitalized due to fluid overload or hyperkalemia. Participants reporting food insecurity missed more dialysis treatments (Table 1). Food insecurity was not associated with all-cause hospitalization, but the association differed by age group (food insecurity x age group interaction term p = 0.14). In bivariate analyses, food insecurity increased relative hazard of fluid or electrolyte-related hospitalization.

Conclusion

This is the first report of associations between food insecurity and outcomes among adults on hemodialysis. Food insecurity was associated with missed treatments and fluid or electrolyte-related hospitalizations.

Funding

  • Other NIH Support