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.

Keywords: Coronavirus disease 2019; End-stage renal disease; Food insecurity; Kidney disease; Nutritional status.

Fig. 1

A Prevalence of food insecurity at Seattle Children’s Hospital and Riley Hospital for Children; 2019 pre-pandemic food insecurity prevalence at Seattle Children’s is included for context (note that no similar pre-COVID pandemic data available for Riley Hospital for Children, ND = No Data). B Change in serum phosphorus (expressed as Δ serum phosphorus, in mg/dL) from before COVID-19 (January/February 2020) to during COVID-19 (April/May 2020) comparing those without food insecurity (no FI) to those with food insecurity (FI)