Abstract: FR-PO1038
Dialysis Disparities: A Systematic Review of Homelessness and ESKD Care Challenges
Session Information
- Social, Environmental, and Economic Determinants of Kidney Health
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
Authors
- Nguyen, Phong T., William Beaumont Army Medical Center, El Paso, Texas, United States
- Acharya, Prakrati C., Texas Tech University Health Sciences Center El Paso, El Paso, Texas, United States
- Thongprayoon, Charat, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Gonuguntla, Sadhana, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, United States
- Zhang, Jennifer, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, United States
- Suppadungsuk, Supawadee, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Krisanapan, Pajaree, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Miao, Jing, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Ahmad, Adeel, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, United States
- Cheungpasitporn, Wisit, Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background
Patients with end-stage kidney disease (ESKD) who are homeless face challenges including medication storage, transportation, adherence to restrictions, dialysis treatments and exacerbating health issues
Methods
We conducted systematic reviews in OVID Medline, Embase, and Cochrane databases up to March 2024 to examine demographic data, substance use, dialysis access, mental health, healthcare utilization, and transplantation outcomes for homeless ESKD patients. Data categories included demographics such as age, ethnicity, and urban vs. rural living; types of dialysis access; psychiatric conditions; and outcomes, including survival rates, hospital visits, and transplantation suitability. The protocol was registered in PROSPERO CRD42024509023.
Results
6 studies were identified involving 986 homeless ESKD individuals. The prevalence of homelessness among ESKD patients varied from 0.35% to 32.6%, with varying sample sizes in these studies. 4 studies with a total of 58003 ESRD patients, had 900 homeless patients, thus with a prevalence of 1.5%. The largest study involved veterans, demonstrating that approximately 3% had both ESKD and homelessness. Black patients were particularly affected with over half of the patients being Black in all studies. ESKD patients who were burdened by homelessness were associated with a high risk of 90-day hospital readmission (OR 2.92, 95% CI: 1.02, 13.16, p= 0.05). Patients with unstable housing had a higher risk of death compared with patients with stable housing in one study (adjusted hazard ratio [AHR], 1.20 [95% CI: 1.04-1.37]), with Kaplan-Meier analysis demonstrating 1-year and 4-year survival rates of 94.4% and 80.6%, respectively. Homelessness is an independent risk factor for ESKD, with incidence rates of ESKD significantly higher than stable housing peers (10.9 vs. 7.4 per 1000 person-years) in one study. These patients also faced mental health and substance abuse disorders.
Conclusion
Homelessness significantly impedes the management of ESKD. The data highlight the critical need for integrated healthcare services, including stable housing and mental health support. Future research should focus on comprehensive data collection to better address the barriers faced by homeless ESKD patients in getting necessary treatments