Kidney Week

Abstract: TH-PO1211

Neighborhood Deprivation Is Associated with Fluid Overload and Metabolic Outcomes in Pediatric Patients on Hemodialysis (HD)

Session Information

• Pediatric Nephrology: CV Health, CKD, AKI, Dialysis, Transplantation, and Health Services Research
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1800 Pediatric Nephrology

Authors

• Pottanat, Neha D., Indiana University School of Medicine, Indianapolis, Indiana, United States

Neha D. Pottanat, MD, FASN

• Glenn Lecea, Eva M., University of California San Francisco, San Francisco, California, United States

Eva M. Glenn Lecea, MD

• Mccuistion, Austin, Children's Hospital Colorado, Aurora, Colorado, United States

Austin Mccuistion, MD, MEd

• Ruikka, Jessica, University of Michigan Medical School, Ann Arbor, Michigan, United States

Jessica Ruikka, DO

• Brunson, Celina, Children's National Hospital, Washington, District of Columbia, United States

Celina Brunson, MD, MSc

• Gavcovich, Tara Bree, University of Miami Miller School of Medicine, Miami, Florida, United States

Tara Bree Gavcovich, MD

• Winnicki, Erica, University of California San Francisco, San Francisco, California, United States

Erica Winnicki, MD

• Shih, Weiwen Vivian, Children's Hospital Colorado, Aurora, Colorado, United States

Weiwen Vivian Shih, MD

• Luckritz, Kera E., University of Michigan Medical School, Ann Arbor, Michigan, United States

Kera E. Luckritz, DO, MPH

• Nguyen, Duc T., Baylor College of Medicine, Houston, Texas, United States

Duc T. Nguyen, MD, PhD

• Nobleza, Kenneth, Baylor College of Medicine, Houston, Texas, United States

Kenneth Nobleza, MS

• Onugha, Elizabeth Anyaegbu, Baylor College of Medicine, Houston, Texas, United States

Elizabeth Anyaegbu Onugha, MD, MS, MSc, FASN

Background

Children with end stage kidney disease (ESKD) are disproportionately affected by social disparities. Pediatric patients are also vulnerable to food and nutrition insecurity (FNI), which may contribute to adverse cardiovascular and metabolic outcomes. We evaluated associations between neighborhood disadvantage, FNI, and clinical outcomes in children receiving chronic HD.

Methods

43 patients aged 2–19 years receiving chronic HD for ≥3 months (10/2023–3/2026) across 7 centers were screened for food insecurity (Hunger Vital Sign) and nutrition insecurity (Tufts University). Area Deprivation Index (ADI), a measure of socioeconomic disadvantage, was calculated. Outcomes, included hypertension, fluid overload (FO), and serum potassium and phosphorus. FO was defined as interdialytic weight gain (IDWG) >5% or need for additional or extended HD. Exposures were assessed cross-sectionally, with outcomes ascertained over the prior 90 days. Group differences were analyzed using Fisher’s exact and Kruskal–Wallis or t tests.

Results

Among 43 patients, >50% are racial/ethnic minorities and 67% reported FNI; only 31% receive SNAP and 21% school meals. 81% reside in disadvantaged neighborhoods (ADI 25–100), with similar FNI rates across ADI groups. Patients from more disadvantaged areas were more likely to have IDWG >5% and require additional/extended HD for FO (40% vs 0%, p=0.04), and to have normal potassium levels (<5.0 mEq/L; 85.7% vs 25%, p=0.002).

Conclusion

These findings demonstrate some of the first data in ESKD that neighborhood disadvantage and reduced access to affordable, nutritious foods contribute to FO–related complications while obscuring conventional biochemical markers of diet quality. Structural barriers to fresh, nutrient dense, low sodium foods likely drive these patterns and represent a modifiable source of cardiovascular and metabolic risk. Further study will define the impact of FNI on long term outcomes in pediatric ESKD.