TY - JOUR
T1 - “I have to pick my battles”
T2 - a mixed-methods study exploring food insecurity and dietary restrictions in pediatric kidney disease
AU - Krissberg, Jill R.
AU - Jones, Mickayla
AU - Guzman, Zecilly
AU - Chen, Wenya
AU - Sheehan, Karen
AU - Verghese, Priya S.
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to International Pediatric Nephrology Association 2024.
PY - 2025/2
Y1 - 2025/2
N2 - Background: Food insecurity (FI) is prevalent among children with chronic kidney disease (CKD), but its impact on health outcomes, and feasibility of prescribed diet restrictions is unknown. Accordingly, this study aims to explore associations of FI and CKD outcomes, and understand its role in following prescribed kidney diet recommendations. Methods: We performed 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 was 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. Major themes that emerged from caregiver interviews include (1) understanding of the kidney diet focuses on foods to avoid; (2) adapting to suggested dietary restrictions requires changes in meal preparation; and (3) challenges to adherence include social stigma, growth, budget, and time. Conclusions: 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. Challenges involve food availability, a child’s response to restrictions, and social stigma.
AB - Background: Food insecurity (FI) is prevalent among children with chronic kidney disease (CKD), but its impact on health outcomes, and feasibility of prescribed diet restrictions is unknown. Accordingly, this study aims to explore associations of FI and CKD outcomes, and understand its role in following prescribed kidney diet recommendations. Methods: We performed 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 was 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. Major themes that emerged from caregiver interviews include (1) understanding of the kidney diet focuses on foods to avoid; (2) adapting to suggested dietary restrictions requires changes in meal preparation; and (3) challenges to adherence include social stigma, growth, budget, and time. Conclusions: 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. Challenges involve food availability, a child’s response to restrictions, and social stigma.
KW - Chronic kidney disease
KW - Dialysis
KW - Diet
KW - Disparities
KW - Food insecurity
KW - Pediatric
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U2 - 10.1007/s00467-024-06506-2
DO - 10.1007/s00467-024-06506-2
M3 - Article
C2 - 39325171
AN - SCOPUS:85204923408
SN - 0931-041X
VL - 40
SP - 473
EP - 481
JO - Pediatric Nephrology
JF - Pediatric Nephrology
IS - 2
ER -