Financial Toxicity in ESKD

Abstract

Background: Patients with kidney failure require treatments that are demanding and time-intensive, potentially interfering with employability and leading to indirect costs. We sought to characterize the prevalence of, and risk factors for financial toxicity among patients with kidney failure.

Methods: We conducted a cross-sectional survey study of 112 participants with kidney failure at a large, urban, academic medical center. Financial toxicity was assessed via a survey which included the validated CoST tool as well as additional items to evaluate self-reported changes to material conditions and financial coping behaviors. Participants were grouped according to kidney replacement therapy modality (dialysis, transplant after dialysis, or preemptive transplant) Descriptive statistics were used to summarize demographic and clinical characteristics of the study population and to compare those with above-median vs below-medial CoST scores, and by modality of kidney replacement therapy.

Results: Median CoST score was 17 with 71% of participants experiencing at least mild financial toxicity. Participants experiencing financial toxicity were less likely to have White race, and more likely to be receiving dialysis. Over half of participants reported reduction in employment (61%) or income (57%) following kidney failure onset with the greatest likelihood of these among participants with any dialysis.

Conclusions: Adults with kidney failure experience significant financial toxicity as measured by the CoST score and report significant negative changes in employment and income. Although this toxicity persists through many stages of treatment, treatment modality may impact financial burdens experienced by patients with kidney failure.