Abstract: FR-PO1082
Housing Instability and Food Insecurity Among Patients Who Transitioned from Home-Based to In-Center Hemodialysis: A National Survey
Session Information
- Home Dialysis: Modalities, Barriers, Utilization, and Clinical Outcomes
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Garimella, Pranav S., American Kidney Fund, Rockville, Maryland, United States
- Woolley, Ryan, American Kidney Fund, Rockville, Maryland, United States
- Lakhani, Shahzia A., American Kidney Fund, Rockville, Maryland, United States
- Hall, Joy, American Kidney Fund, Rockville, Maryland, United States
- Dewberry, Gwen, American Kidney Fund, Rockville, Maryland, United States
- de Paz Aguilar, Carlos Humberto, American Kidney Fund, Rockville, Maryland, United States
- Spigler, Michael, American Kidney Fund, Rockville, Maryland, United States
Background
Housing instability may drive transitions from home-based dialysis to in-center hemodialysis (HD), yet this relationship remains understudied. We examined social determinants of health (SDOH) burden and reasons for modality transition among patients who previously used home-based dialysis (home HD or peritoneal dialysis) and transitioned to in-center HD.
Methods
We disseminated an online survey in both English and Spanish to a sample of 10,000 people receiving need-based financial assistance with a history of end-stage kidney disease. Housing instability was defined as a composite of 5 indicators. Food insecurity was assessed using the 2-item Hunger Vital Sign. Reasons for switching from home-based to in-center dialysis were classified as housing-related or other and free-text responses were thematically coded.
Results
We received 1,100 complete responses. Of 697 in-center HD patients who responded to the home dialysis experience question, 104 (14.9%) reported prior home-based dialysis use before transitioning to in-center HD. Among these, 53% had unstable housing and 53% were food insecure. Males comprised a greater proportion of housing-unstable patients (68% vs. 45%, p=0.032). Food insecurity was markedly higher among housing-unstable patients (70% vs. 34%, p<0.001). Of 102 patients with reasons for switching, 14 (13.5%) cited housing-related barriers including eviction risk (n=6), inadequate utilities (n=3), home safety concerns (n=3), and landlord refusal (n=2). People who switched due to housing-related reasons had significantly higher housing instability (86% vs. 48%, p=0.018). Predominant themes of 84 free-text responses were infection/medical complication (25%), medical/surgical reason (19%), treatment ineffectiveness (17%), and caregiver burden (17%). Housing instability did not differ significantly between transitioning patients and those never on home-based dialysis (53% vs. 46%, p=0.4).
Conclusion
Over half of patients who transitioned from home-based dialysis to in-center HD experience concurrent housing instability and food insecurity. Housing-related barriers directly precipitate modality transitions in 14% of this cohort, and these patients face disproportionately severe and persistent SDOH burden. Routine SDOH screening in home dialysis programs may identify patients at risk for modality transition.