Food Insecurity and Risk of Hospitalization among Adults Receiving In-Center Hemodialysis

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.