Effect of Neighborhood Food Environment and Socioeconomic Status on Serum Phosphorus Level for Patients on Chronic Dialysis
- 1 November 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American Society of Nephrology
- Vol. 31 (11), 2622-2630
- https://doi.org/10.1681/ASN.2020030290
Abstract
Background Elevated blood phosphorus levels are common and associated with a greater risk of death for patients receiving chronic dialysis. Phosphorus-rich foods are prevalent in the American diet, and low-phosphorus foods, including fruits and vegetables, are often less available in areas with more poverty. The relative contributions of neighborhood food availability and socioeconomic status to phosphorus control in patients receiving dialysis are unknown. Methods Using longitudinal data from a national dialysis provider, we constructed hierarchical, linear mixed-effects models to evaluate the relationships between neighborhood food environment or socioeconomic status and serum phosphorus level among patients receiving incident dialysis. Results Our cohort included 258,510 patients receiving chronic hemodialysis in 2005-2013. Median age at dialysis initiation was 64 years, 45% were female, 32% were Black, and 15% were Hispanic. Within their residential zip code, patients had a median of 25 "less-healthy" food outlets (interquartile range, 11-40) available to them compared with a median of four "healthy" food outlets (interquartile range, 2-6). Living in a neighborhood with better availability of healthy food was not associated with a lower phosphorus level. Neighborhood income also was not associated with differences in phosphorus. Patient age, race, cause of ESKD, and mean monthly dialysis duration were most closely associated with phosphorus level. Conclusions Neither neighborhood availability of healthy food options nor neighborhood income was associated with phosphorus levels in patients receiving chronic dialysis. Modifying factors, such as nutrition literacy, individual-level financial resources, and adherence to diet restrictions and medications, may be more powerful contributors than food environment to elevated phosphorus.Funding Information
- American Society of Nephrology
- National Kidney Foundation
- National Institutes of Health (K23-HL133843)
- National Institute of Allergy and Infectious Diseases (K24AI146137)
- Collaborative Healthcare Research & Data Analytics
This publication has 35 references indexed in Scilit:
- Phosphate-Binder Use in US Dialysis Patients: Prevalence, Costs, Evidence, and PoliciesAmerican Journal of Kidney Diseases, 2018
- Removal of Phosphorus by HemodialysisSeminars in Dialysis, 2015
- The Prevalence of Phosphorus-Containing Food Additives in Top-Selling Foods in Grocery StoresJournal of Renal Nutrition, 2013
- Oral Phosphate Binders in Patients with Kidney FailureThe New England Journal of Medicine, 2010
- Association of Dietary Phosphorus Intake and Phosphorus to Protein Ratio with Mortality in Hemodialysis PatientsClinical Journal of the American Society of Nephrology, 2010
- Understanding Sources of Dietary Phosphorus in the Treatment of Patients with Chronic Kidney DiseaseClinical Journal of the American Society of Nephrology, 2010
- Phytate in foods and significance for humans: Food sources, intake, processing, bioavailability, protective role and analysisMolecular Nutrition & Food Research, 2009
- Improving Outcomes for Dialysis Patients in the International Dialysis Outcomes and Practice Patterns StudyClinical Journal of the American Society of Nephrology, 2006
- Estimating phosphate removal in haemodialysis: an additional tool to quantify dialysis doseNephrology Dialysis Transplantation, 2002
- Dialyzer Performance in the Clinic: Comparison of Six Low‐Flux MembranesArtificial Organs, 1999