Intersection of Housing Instability and Food Insecurity Among Individuals Living with ESKD

Background: Housing instability and food insecurity can create substantial barriers to disease management, complicate treatment adherence, and severely impact quality of life. While research has explored the individual impacts of housing instability and food insecurity on various chronic conditions, there is a lack of data quantifying burden in the end-stage kidney disease (ESKD) population. Understanding the prevalence of this dual burden is crucial for developing targeted interventions and advocating for policies that address the unique needs of these individuals. Methods: In December 2024, the American Kidney Fund (AKF) disseminated an online survey, available in both English and Spanish, to a random sample of 10,000 patients with ESKD who receive need-based, charitable assistance from AKF. Housing instability was assessed via a validated 7-item Housing Instability Scale and food security was assessed using the Hunger Vital SignTM. Results: A total of 1,227 participants completed the survey. Respondent characteristics are reported in Table 1. Forty-seven percent of respondents reported at least one housing related issue and 61% reported food insecurity. Overall, 62% of respondents who are food insecure are also experiencing at least one housing instability related issue and 81% who are experiencing housing instability are food insecure. Conclusion: While our study participants represent a low-income ESKD population, the high rates of food insecurity and housing instability, despite the financial assistance patients receive, indicate severe burdens faced by this group. Future research should assess the burdens of housing instability and food insecurity in additional subgroups who aren’t receiving financial assistance. Additionally, future research is warranted to determine policies and interventions to help address equitable access to housing and food among the ESKD population.