Abstract
KEY POINTS: Food insecurity was not associated with all-cause hospitalization but was associated with fluid or electrolyte-related hospitalization. Younger adults receiving hemodialysis may be more susceptible to food insecurity and should be a priority subpopulation for related interventions. Participants reporting food insecurity were more likely to miss dialysis treatments, suggesting food insecurity may affect outcomes through adherence. BACKGROUND: Food insecurity is common among people receiving in-center hemodialysis and living in residentially segregated communities. Food insecurity is associated with hospitalization in other chronic diseases but is understudied in the adult dialysis population. METHODS: We examined the association of food insecurity with all-cause hospitalization risk among adults receiving in-center hemodialysis. From February through December 2021, we conducted a prospective cohort study of adults at 17 dialysis facilities in Maryland, Washington DC, and Virginia. Participants completed a food insecurity survey at baseline and were monitored through their dialysis facility electronic medical record for 6 months. We censored participants upon change in dialysis modality, kidney transplantation, transfer to a nonparticipating dialysis facility, loss to follow-up, death, or end of the study follow-up period. RESULTS: We enrolled 322 participants. Of the 288 participants with survey and clinical record data, 61 (22%) reported food insecurity in the previous year and 91 (32%) experienced an all-cause hospitalization. Thirty-nine (13%) participants were censored before the end of the study period. Food insecurity was not a significant predictor of all-cause hospitalization in the full sample (adjusted hazard ratio [aHR], 1.06; 95% confidence interval [CI], 0.63 to 1.8). In exploratory analyses, all-cause hospitalization risk differed among younger and older participants reporting food insecurity, suggesting effect modification by age group (<55 years: aHR, 2.00; 95% CI, 0.91 to 4.42; ≥55 years: aHR, 0.63; 95% CI, 0.28 to 1.41; P value for interaction, 0.06). The risk of fluid or electrolyte-related hospitalizations among participants reporting food insecurity was three-fold higher than participants who were food secure (aHR, 3.04; 95% CI, 1.16 to 7.96). CONCLUSIONS: In a cohort of adults receiving in-center hemodialysis, food insecurity was not associated with all-cause hospitalization but was associated with fluid or electrolyte-related hospitalization. Younger adults receiving in-center hemodialysis may be more susceptible to consequences of food insecurity.