May 17, 2023
Addressing Food Insecurity Key in Creating Health Equity in Kidney Care

Access to healthy, nutritional food is a key factor in maintaining overall health. It’s so vital that food insecurity—not having access to sufficient food of adequate quality—is a key social determinant of health and a critical component of health equity.

For people with chronic kidney disease (CKD) and end-stage kidney disease (ESKD), food insecurity can come with significant consequences. For people with CKD, food insecurity is associated with a 38% higher likelihood of progression to ESKD[1]. And once someone experiences kidney failure, nutritional needs become even more complex as they track certain nutrients to manage their health and avoid hospitalizations.

Kidney disease patients are reported to experience food insecurity at higher rates than the general public. While the U.S. Department of Agriculture (USDA) reports that 10% of people in the U.S. experience food insecurity[2], studies show it affects about 16% of people with ESKD[3].

“Maintaining health and diet can be a vicious cycle for many patients, especially those who are low-income or live in poverty,” Mary Van Jacobs, senior administrator for DaVita’s Village Giving team, says. “It can be a constant struggle for them to make sure all of their needs are being met.”

For many patients, adhering to health and diet plans comes down to two main contributing factors that often lead to food insecurity: accessibility and affordability. Grocery prices have risen about 11% over the last year, according to the USDA; and not having affordable access to proper nutrition can lead to diets of high-calorie, high-phosphorus foods and lacking in fruits and vegetables. This is especially critical for key kidney-health measures, including blood sugar, blood pressure and fluid status.

In 2022, the DaVita Giving Foundation announced a $1.4 million grant to the Food Is Medicine Coalition (FIMC) to help provide more than 100,000 medically-tailored meals to people with chronic illness experiencing food insecurity, including individuals living with ESKD.

FIMC comprises nonprofit, medically-tailored-meal providers across the U.S. These organizations are committed to serving people who experience chronic illness and food insecurity. Through these organizations, registered dietitians and social workers work with patients to tailor meal plans according to their medical needs.

“Many of our patients live in food deserts (areas with limited access to nutritious foods) or food swamps (areas with excessively high-calorie food sources),” Amber Pace, senior director for DaVita’s national social work team, says. “This can make it really difficult to maintain a nutritious diet, especially for those patients who are on a fixed income.”

Attending dialysis treatments can add another element to managing kidney diet needs. Patients receive education and guidance on adhering to a kidney-healthy diet, but education often isn’t enough.

Jackie Termont, dietitian lead for DaVita, explains patients in out-patient dialysis commonly experience exhaustion after treatment, which often consists of three to four hours of treatment three days a week. This can lead to patients consuming quick, on the go type meals, which are often unhealthy.

Through its grant work with FIMC, DaVita will help address both concerns for many of its patients. Once DaVita identifies individuals who are eligible for medically-tailored meal options, DaVita connects them with programs in their region. Then, upon application approval, DaVita determines how to create convenience for patients in the program: whether they want meals delivered at home or in their dialysis centers.

Alissa Wassung, executive director for FIMC, says it can be easy for food insecurity to become an afterthought. She credits organizations like DaVita for identifying the need for solutions and taking action.

“The wonderful thing about our collaboration with DaVita and the DaVita Giving Foundation is that we’re both national organizations with a local focus,” Wassung says. “DaVita is very intentional with that focus, and receiving this grant has been transformative.”

With the support of the DaVita Giving Foundation, the programs will provide meals to 415 patients across four geographies. Van Jacobs says the programs will track health outcomes like lab values and hospitalization rates to better understand the overall impact of medically-tailored meals for patients.

“What we’re hearing from our patients is that if they have the opportunity to receive free meals, they’ll save the money that’s normally used to buy food and use it to pay for gas, rent or medications,” Van Jacobs explains. “Often they’re a paycheck away from not being secure. These programs are truly helping them stabilize their situation.”

As DaVita measures the impact of its grant work with FIMC, the goal is to continue finding equitable solutions to improve patient health, says Pace.

“The more we can support our patients in being able to access medically-tailored meals, the more successful [we believe] they’ll be in managing their health and well-being.”

[1] After adjustment for demographics, income, diabetes, hypertension, eGFR and albuminuria.

Mokiao, Reya1,2; Hingorani, Sangeeta1,2. Food Insecurity and Kidney Disease: Symptoms of Structural Racism. CJASN 16(12):p 1903-1905, December 2021. | DOI: 10.2215/CJN.07860621

[3] Mokiao, Reya1,2; Hingorani, Sangeeta1,2. Food Insecurity and Kidney Disease: Symptoms of Structural Racism. CJASN 16(12):p 1903-1905, December 2021. | DOI: 10.2215/CJN.07860621