Cognitive, functional, and social disparities in patients receiving dialysis: a multi-site survey

End-stage kidney disease (ESKD) affects many Americans, with higher risks in certain subgroups of the US population. Differential kidney health outcomes may stem from non-medical social drivers of health, cognitive difficulties, and functional limitations. Recommendations for individuals with ESKD are often standardized and may not account for unique challenges and access barriers that individuals face. These challenges lead to preventable differences in access to treatments such as home dialysis and kidney transplantation. This study examines the prevalence of unmet social, cognitive, and functional needs amongst patients receiving dialysis and evaluates the intersection of these barriers to inform strategies to improve kidney health outcomes for all patients.

In a cross-sectional study, a convenience sample of 962 patients from diverse backgrounds, currently undergoing dialysis from multiple dialysis centers across the United States (aged 21-95 years), were surveyed. Descriptive, Spearman's correlation, logistic regression, and Chi-Square Test analyses conducted.

From our large sample, 45.1% reported memory challenges, 19.6% required assistance with activities of daily living (ADLs), and 51.0% experienced two or more mobility limitations. Additionally, 20.4% reported difficulty accessing healthcare, while 16.3% faced challenges obtaining medications. A subset (12.2%) of participants experienced overlapping social, cognitive, and functional barriers. Unmet needs were disproportionately higher amongst public insurance participants compared to those with private insurance, with 33.0% of Dual-eligible participants reporting three or more unmet needs.

This study highlights the significant intersection of social, cognitive, and functional barriers faced by patients receiving dialysis with ESKD, particularly those from vulnerable populations. Addressing these multifaceted needs through person-centered interdisciplinary care models and policy interventions is critical to reducing disparities and improving outcomes in kidney health outcomes.