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Food Insecurity, CKD, and Subsequent ESRD in US Adults
- Banerjee, Tanushree;
- Crews, Deidra C;
- Wesson, Donald E;
- Dharmarajan, Sai;
- Saran, Rajiv;
- Burrows, Nilka Ríos;
- Saydah, Sharon;
- Powe, Neil R;
- Team, CDC CKD Surveillance;
- Powe, Neil R;
- Banerjee, Tanushree;
- Hsu, Chi-yuan;
- Bibbins-Domingo, Kirsten;
- McCulloch, Charles;
- Crews, Deidra;
- Grubbs, Vanessa;
- Peralta, Carmen;
- Shlipak, Michael;
- Rubinsky, Anna;
- Hsu, Raymond;
- Coresh, Josef;
- Tuot, Delphine;
- Saran, Rajiv;
- Steffick, Diane;
- Gillespie, Brenda;
- Herman, William;
- Port, Friedrich;
- Robinson, Bruce;
- Shahinian, Vahakn;
- Yee, Jerry;
- Young, Eric;
- McClellan, William;
- O’Hare, Ann;
- Fava, Melissa;
- Tilea, Anca;
- Williams, Desmond;
- Burrows, Nilka Ríos;
- Eberhardt, Mark;
- Flowers, Nicole;
- Geiss, Linda;
- Jordan, Regina;
- Mondesire, Juanita;
- Moore, Bernice;
- Myers, Gary;
- Pavkov, Meda;
- Rolka, Deborah;
- Saydah, Sharon;
- Schoolwerth, Anton;
- Valdez, Rodolfo;
- Waller, Larry
Published Web Location
https://doi.org/10.1053/j.ajkd.2016.10.035Abstract
Background
Poor access to food among low-income adults has been recognized as a risk factor for chronic kidney disease (CKD), but there are no data for the impact of food insecurity on progression to end-stage renal disease (ESRD). We hypothesized that food insecurity would be independently associated with risk for ESRD among persons with and without earlier stages of CKD.Study design
Longitudinal cohort study.Setting & participants
2,320 adults (aged ≥ 20 years) with CKD and 10,448 adults with no CKD enrolled in NHANES III (1988-1994) with household income ≤ 400% of the federal poverty level linked to the Medicare ESRD Registry for a median follow-up of 12 years.Predictor
Food insecurity, defined as an affirmative response to the food-insecurity screening question.Outcome
Development of ESRD.Measurements
Demographics, income, diabetes, hypertension, estimated glomerular filtration rate, and albuminuria. Dietary acid load was estimated from 24-hour dietary recall. We used a Fine-Gray competing-risk model to estimate the relative hazard (RH) for ESRD associated with food insecurity after adjusting for covariates.Results
4.5% of adults with CKD were food insecure. Food-insecure individuals were more likely to be younger and have diabetes (29.9%), hypertension (73.9%), or albuminuria (90.4%) as compared with their counterparts (P<0.05). Median dietary acid load in the food-secure versus food-insecure group was 51.2 mEq/d versus 55.6 mEq/d, respectively (P=0.05). Food-insecure adults were more likely to develop ESRD (RH, 1.38; 95% CI, 1.08-3.10) compared with food-secure adults after adjustment for demographics, income, diabetes, hypertension, estimated glomerular filtration rate, and albuminuria. In the non-CKD group, 5.7% were food insecure. We did not find a significant association between food insecurity and ESRD (RH, 0.77; 95% CI, 0.40-1.49).Limitations
Use of single 24-hour diet recall; lack of laboratory follow-up data and measure of changes in food insecurity over time; follow-up of cohort ended 10 years ago.Conclusions
Among adults with CKD, food insecurity was independently associated with a higher likelihood of developing ESRD. Innovative approaches to address food insecurity should be tested for their impact on CKD outcomes.Many UC-authored scholarly publications are freely available on this site because of the UC's open access policies. Let us know how this access is important for you.