Beyond the Plate: Exploring Food and Cooking Barriers to Dietary Adherence in Patients on Hemodialysis

Background: Sodium restriction is essential for hemodialysis (HD) patients to manage fluid balance and cardiovascular risk. However, adherence remains low, particularly when patients are responsible for shopping and cooking their own meals. Prior lab findings suggested educational efforts alone were insufficient. This study aimed to identify the practical barriers HD patients face in shopping for, preparing, and consuming low-sodium meals. Methods: A bilingual, cross-sectional survey was administered to the first 15 adult HD patients enrolled at two dialysis clinics in Tucson, Arizona. Survey domains included: perceived food availability, utilization barriers (e.g., access to cooking equipment or skills), nutrition and food security (including the USDA Six-Item Short Form), and personal dietary choice behaviors. Descriptive statistics were used to identify prevalent barriers. Results: Among participants, 40% reported that they sometimes or often were unable to obtain healthy food, despite understanding its importance. One-third (33.3%) indicated they ate the same foods repeatedly due to financial limitations. Only 33% reported that they always have control over access to fruits and vegetables, while 20% reported no control at all. Processed food reliance was prevalent; only 20% of participants stated they never relied on such items, and most reported inconsistent control over avoiding them. Socioeconomic data further contextualized these barriers: 67% of participants reported household incomes under $30,000 per year, 80% relied on government-sponsored insurance, and 93.4% were unemployed, disabled or retired. Most patients reported shopping primarily at supermarkets or discount retailers, with only 27% accessing wholesale food clubs. Conclusion: These preliminary findings suggest that structural insecurity and inconsistent food access, not lack of knowledge are key barriers to sodium adherence. These challenges are especially pronounced among low-income, Hispanic HD patients. Though enrollment in this study continues, these trends will help guide the development of targeted interventions that address not only education but also financial, environmental, and cultural constraints. Funding: Private Foundation Support