Food insecurity during COVID-19 in children with end-stage kidney disease: a pilot study

Abstract

Background Food insecurity, an important social determinant of health among children, has become more common during the COVID-19 pandemic. Children with chronic diseases including end-stage kidney disease (ESKD) are at higher risk of food insecurity due to their complex care needs, medication burden, and dietary restrictions. No data exists describing food insecurity prevalence in pediatric ESKD patients during the COVID-19 pandemic. Methods Food insecurity was assessed among families of children (age 0–18 years) with ESKD on chronic dialysis at two pediatric academic medical centers. Families were screened in April 2020 using the Hunger Vital Sign, a validated 2-question screening tool. We assessed impact of COVID-19 on food insecurity. We compared serum phosphorus “pre-COVID” (January/February 2020) to “during COVID” (April/May 2020). Results A total of 29 families enrolled in this study. 62% (18/29) of children with ESKD lived in food insecure households, and of those, 72% (13/18) reported that COVID-19 had worsened their food insecurity status. During the COVID-19 pandemic, food insecure patients experienced greater rise in their serum phosphorus levels (1.1 mg/dL vs. 0 mg/dL, p = 0.03) and decreased likelihood of having adequate phosphorus control (50% vs. 11%, p = 0.03). Conclusion Food insecurity was common among children with ESKD on chronic dialysis during the COVID-19 pandemic. Children with food insecurity had a greater increase in their phosphorus levels during the pandemic than did food secure children. Further exploration into how food resources such as an onsite food pantry impacts food insecurity and phosphorus control in children with ESKD is essential.

Improving food insecurity screening across a health system throughout the COVID-19 pandemic

“…Our study adds to the literature on addressing food insecurity. Many paediatric food insecurity screening projects focus specifically on primary care clinics18–22 or individual specialty clinics 23–25. Our study includes a much larger population (>1 70 000 encounters) than the limited number of published multispecialty and multisite projects addressing food insecurity in paediatrics,26 and spans an entire 3-year study period.…”

“…Many paediatric food insecurity screening projects focus specifically on primary care clinics [18][19][20][21][22] or individual specialty clinics. [23][24][25] Our study includes a much larger population (>1 70 000 encounters) than the limited number of published multispecialty and multisite projects addressing food insecurity in paediatrics, 26 and spans an entire 3-year study period. Palakshappa et al reported postintervention screening rates from 68.4% to 90.1% across six primary care practices and from 14.2% to 93.6% across individual clinicians.…”