Abstract
KEY POINTS: Adults with kidney failure experience financial toxicity as measured by the Comprehensive Score for Financial Toxicity tool. Adults with kidney failure experiencing financial toxicity report a high rate of reduced workforce participation. Although financial toxicity persists through many stages of kidney failure treatment, it is most prevalent among those on dialysis. BACKGROUND: Patients with kidney failure require treatments that are demanding and time intensive, potentially interfering with employability and leading to indirect costs. We sought to characterize the prevalence and risk factors of financial toxicity among patients with kidney failure. METHODS: We conducted a cross-sectional survey study of 112 participants with kidney failure at a large, urban, academic medical center. Financial toxicity was assessed by using a survey that included the validated Comprehensive Score for Financial Toxicity (CoST) tool as well as additional items to evaluate self-reported changes in material conditions and financial coping behaviors. Participants were grouped according to KRT modality (dialysis, transplant after dialysis, or preemptive transplant). Descriptive statistics were used to summarize demographic and clinical characteristics of the study population and to compare those with above-median versus below-median CoST scores and by modality of KRT. RESULTS: The median CoST score was 17, with 71% of participants experiencing at least mild financial toxicity. Participants experiencing financial toxicity were less likely to have White race and more likely to be receiving dialysis. Over half of participants reported reduction in employment (61%) or income (57%) after kidney failure onset with the greatest likelihood of these among participants with any dialysis. CONCLUSIONS: Adults with kidney failure experience significant financial toxicity as measured by the CoST score and report significant negative changes in employment and income. Although this toxicity persists through many stages of treatment, treatment modality may affect financial burdens experienced by patients with kidney failure.