476 - Assessing Food and Nutrition Insecurity in Pediatric End-Stage Kidney Disease (ESKD): Insights from a Multicenter Hemodialysis (HD) Cohort

Publication Number: 2464.476

Neha D. Pottanat, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Eva M. Glenn Lecea, UCSF Benioff Children's Hospital San Francisco, SAN FRANCISCO, CA, United States; Austin G. McCuistion, Children's Hospital Colorado, Denver, CO, United States; Jessica Ruikka, University of Michigan Medical School, Ann Arbor, MI, United States; Kathy A. Nordquist, Riley Hospital for Children at Indiana University Health, Dunedin, FL, United States; Celina Brunson, Children's National Health System, Silver Spring, MD, United States; Tara Gavcovich, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States; Erica Winnicki, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA, United States; Weiwen V. Shih, University of colorado, Aurora, CO, United States; Kera Luckritz, University of Michigan Medical School, Ann Arbor, MI, United States; Elizabeth A. Onugha, Baylor College of Medicine, Houston, TX, United States

Background: Food insecurity (FI) is rising among children with chronic kidney disease and is a key social determinant of health. Diets high in sodium and phosphorus are more affordable but contribute to adverse outcomes, including cardiovascular disease. While screening tools like the Hunger Vital Sign identify cost-related food access issues, they do not assess nutritional quality. And while patients may be eligible for government assistance through programs like Supplemental Nutrition Assistance Program (SNAP) and school-based nutrition programs, those receiving in-center HD have intermittent school attendance due to their treatment schedule, which reduces access.

Objective: To compare the prevalence of FI, nutrition insecurity (NI), and other contributing factors among pediatric patients receiving chronic HD across 6 U.S. hospital-based dialysis units.

Design/Methods: Patients aged 2-19 years receiving chronic HD for ≥3 months between November 2024 and October 2025 were screened using the Hunger Vital Sign and a validated NI tool (by Tufts University/Kaiser Permanente). Demographic data and social needs assessment data were collected from electronic health records. Neighborhood-level socioeconomic disadvantage was geocoded using patient's residential address using the Area Deprivation Index (ADI), a validated composite measure derived from indicators including income, education, employment, and housing quality. ADI scores (0-100) were divided into quartiles, with Q1 indicating the least socioeconomic disadvantage and Q4 the greatest.

Results: Of 36 HD patients, median age 15 years, 67% were male; >50% identified as racial and ethnic minorities. FI and NI were present in 53% of patients; the NI screening identified an additional 5 patients (14%), who did not report food insecurity. Only 22% qualified for SNAP and 22% received public-school meals. While 50% could order hospital meal trays during dialysis, 31% had access to a hospital-based food pantry. Patients were evenly distributed across the different ADI quartiles (Figure 1). See Table 1 for additional demographics and social descriptors.

Conclusion(s): To our knowledge, this is the first study to report such a high prevalence of food and nutrition insecurity among children receiving chronic HD, who also face limited access to support programs. Notably, NI screening identified additional at-risk patients beyond traditional FI measures, underscoring the need for broader assessment tools and targeted interventions that address dietary quality in children with ESKD.

Figure 1: Proportion of patients each ADI quartile
ADI: Area Deprivation Index, Q: Quartile
ADI Q1: Score 0-24, ADI Q2: Score 25-49, ADI Q3: Score 50-74, ADI Q4: Score 75-100

Table 1: Demographics and Social Descriptors