Kathryn Taylor, PhD, MPH, RN

Credit: Johns Hopkins School of Nursing

Results from a prospective cohort study are providing clinicians with an overview of the association between food insecurity and missed treatments and fluid or electrolyte-related hospitalizations among adults on hemodialysis.

The research, which was presented at the American Society of Nephrology Kidney Week 2023, represents one of the first reports of associations between food insecurity and outcomes among adult patients on hemodialysis, a topic investigators noted had previously only been studied in children.¹

“This is one of the first studies that has looked at food insecurity at baseline and followed them into the future to see how often they go into the hospital. What we found was that food insecurity was associated with missed treatments, that that association differs by age group, and that it’s associated with electrolyte hospitalization,” said Kathryn Taylor, PhD, MPH, RN, assistant professor at Johns Hopkins University School of Nursing, in an interview with HCPLive Nephrology.

Among the 808,000 people in the US living with end-stage kidney disease, 69% are on hemodialysis.² Treatment regimens are designed to meet patients’ individual needs, so skipping even 1 session could have serious health consequences including fluid buildup, elevated potassium, and excess phosphorus. Thus, understanding and addressing factors contributing to missed hemodialysis is important for better understanding these patients’ needs and providing them with the best care possible.³

To examine associations between food insecurity and missed treatments or hospitalizations, Taylor and colleagues conducted a prospective cohort study using a convenience sample of adults on hemodialysis from 17 facilities in Maryland, Washington DC, and Virginia from February through November 2021. Per study protocol, participants reported demographics and completed the US Adult Food Security Survey Module at baseline.¹

Investigators collected missed treatment counts and hospital admission and discharge dates, including all-cause and fluid or electrolyte-related, from facility records and created negative binomial regression and Cox models to test associations between food insecurity and missed treatments or hospitalizations. Hospitalization analyses were repeated and stratified by age (<55 or ≥55 years) to account for confounding.¹

Investigators included data for 288 patients who completed surveys and HIPAA authorization. This cohort had a mean age of 60 (range, 27 – 86) years and 58% were male. At baseline, 61 (21%) participants reported food insecurity. During follow-up, 138 participants (48%) missed at least 1 hemodialysis treatment (range, 0 – 29) and 91 (32%) participants were hospitalized (range, 0 – 5), including 20 (7%) for fluid overload or hyperkalemia.¹

Upon analysis, 62% of participants who reported food insecurity missed at least 1 dialysis treatment compared to 45% of food secure patients. Food insecurity was not associated with all-cause hospitalization (hazard ratio [HR], 0.98; confidence interval [CI], 0.6-0.61; P = .94), but it was associated with fluid or electrolyte-related hospitalization (HR, 2.58; CI, 1.04-6.4; P = .04). Investigators pointed out the association between food insecurity and all-cause hospitalization differed by age group, affecting a greater proportion of patients younger than 55 years of age (41%) compared to their older counterparts (27%; interaction term P = .14).¹

“We haven’t collectively answered what can be done about this quite yet, but we’re working on a community health worker intervention that we think could help patients navigate their needs and bridge the gap we’re seeing,” concluded Taylor.

References:

1. Taylor K, Fisher M, Santos S, et al. Association of Food Insecurity and Treatment Nonadherence or Hospitalization Among Adults on Hemodialysis. Paper Presented at: American Society of Nephrology Kidney Week 2023. November 1-5, 2023.
2. National Institute of Diabetes and Digestive and Kidney Diseases. Kidney Disease Statistics for the United States. May 1, 2023. Accessed November 5, 2023. https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease
3. National Kidney Foundation. Missing Dialysis Treatment is Dangerous for Your Health. Accessed November 5, 2023. https://www.kidney.org/atoz/content/missing-dialysis-treatment-dangerous-your-health