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

Abstract

he 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 D.C., and Virginia. Participants completed a food insecurity survey at baseline and were monitored through their dialysis facility electronic medical record for six months. We censored participants upon change in dialysis modality, kidney transplantation, transfer to a non-participating dialysis facility, loss to follow-up, death, or end of the study follow-up period. Results: We enrolled 322 participants. Out 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% CI 0.63 – 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 – 4.42; ≥ 55 years: aHR 0.63, 95% CI 0.28 – 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 – 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. Copyright © 2025 by the American Society of Nephrology...