Abstract
Background
Food insecurity (FI) is prevalent among children with chronic kidney disease (CKD) and kidney failure, but it’s impact on health outcomes, and feasibility of prescribed diet restrictions is unknown.
Methods
A mixed-methods single center cohort study of children with advanced CKD or kidney failure. Demographics, socioeconomic status, and health outcomes were compared across FI status; associations between FI and CKD outcomes were explored using multivariable regression. A qualitative sub-analysis of de-identified caregiver interview transcripts were analyzed for themes around diet restrictions.
Results
There was a trend that FI patients were more likely to be of Black race (33% vs 20%); have public insurance (67% vs 48%); need more blood pressure medications (2 [0.75,3] vs 1 [0,3]); and have a higher likelihood of emergency department (42% vs 25%) or intensive care unit encounters (25% vs 14%). There were no associations of FI and outcomes of interest in multivariate regression. Four major themes emerged from caregiver interviews: 1. Understanding of the kidney diet focuses on foods to avoid; 2. Adapting to suggested dietary restrictions requires changes in meal preparation; 3. Challenges to adherence include social stigma, growth, budget, and time, and 4. Increased public awareness of CKD may help improve adherence.
Conclusion
The impact of FI on children’s medical needs with CKD remains inconclusive but trends suggest a higher risk. Regardless of FI status, adhering to prescribed diet restrictions in kidney disease involves significant dedication of time, and resources, while challenges involve food availability, child’s response to restrictions, and social stigma.