Kidney Week

Abstract: PUB536

Financial Toxicity in Kidney Failure

Session Information

• Publication Only

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Maclay, Lindsey, Columbia University Irving Medical Center, New York, New York, United States

Lindsey Maclay

• Huml, Anne M., Cleveland Clinic, Cleveland, Ohio, United States

Anne M. Huml, MD, MS

• Woodward, Kyle J., Columbia University Irving Medical Center, New York, New York, United States

Kyle J. Woodward

• Yu, Miko, Columbia University Irving Medical Center, New York, New York, United States

Miko Yu, MA

• Mohan, Sumit, Columbia University Irving Medical Center, New York, New York, United States

Sumit Mohan, MD, MPH, FASN

• Husain, Syed Ali, Columbia University Irving Medical Center, New York, New York, United States

Syed Ali Husain, MD, MPH, MA, FASN

Background

Financial toxicity (FT), defined as the combined objective (oFT) and subjective (sFT) economic burden of medical care, has not been explored in end-stage kidney disease (ESKD). We sought to describe the prevalence of FT experienced by patients with ESKD.

Methods

Cross-sectional survey of patients with ESKD undergoing inpatient dialysis, kidney transplant evaluation, or transplant follow-up at our center. The survey, derived from prior studies, measured sFT via the validated Comprehensive Score for Financial Toxicity (CoST) tool, and oFT via patient-reported changes in employment, spending, or maladaptive financial coping mechanisms. Based on prior literature, sFT was defined as CoST <26 (44-26 none, 14-25 moderate, 0-13 severe).

Results

Among 24 respondents, 19 (79%) were on dialysis and 5 (19%) had a functioning kidney transplant after prior dialysis. Median time since incident kidney failure was 2.5 years (IQR 1.6-6.4). Median age was 55 years (IQR 40-69), 38% were female, 39% self-reported Hispanic/Latino ethnicity, 46% had Black/African American race, and 21% had White race. 14 (58%) had Medicaid primary or dual coverage, while 6 (25%) had private insurance.
Median CoST was 14 (IQR 12-22), with 20 respondents (83%) reporting any sFT (COST<26) and 8 (33%) reporting severe sFT (Fig. 1A). 14 reported (58%) household income decrease after dialysis start, with 8 (33%) experiencing >50% reduction. Measures of oFT were common, including 16 (67%) respondents with job loss/reduction and 11 (46%) with maladaptive financial coping mechanisms including withdrawal of emergency savings or utilization of credit card debt (Fig. 1B).

Conclusion

Most patients with ESKD experience FT. Further research is needed to understand risk factors for and consequences of financial toxicity in this population.

Funding

• NIDDK Support