Health-Related Social Needs Are Associated with Lower Self-Reported Quality of Life in Patients on Hemodialysis

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KEY POINTS: Health-related social needs are common in patients on in-center hemodialysis. All quality of life subscores are significantly lower in patients with at least one unmet health-related social needs. BACKGROUND: People on hemodialysis often report lower quality of life (QoL) compared with people not on hemodialysis. People with kidney disease have a high prevalence of health-related social needs (HRSN). The association of HRSN and QoL in people on hemodialysis remains understudied. Although some groups of patients treated with hemodialysis tend to have lower QoL, there exists minimal research investigating the mechanism by which this occurs. METHODS: We surveyed people receiving hemodialysis at five urban dialysis units using the Kidney Disease Quality of Life and the Accountable Health Communities Health-Related Social Needs Screening Tool to assess their housing, food, transportation, utilities, and perceived safety. We calculated physical and mental component scores as well as subscores measuring burden, symptoms, and effect of kidney disease. We analyzed scores using Python packages. We used the Shapiro-Wilk test to assess normality. For analysis we used the Wilcoxon rank-sum test and univariate, multivariate, and least absolute shrinkage and selection operator regressions. RESULTS: A total of 324 patients participated in the study. HRSN was common with 56% of participants reporting at least one HRSN. Food insecurity (35%) and housing instability (24%) was most common. All QoL subscores were significantly lower in patients who had at least one HRSN. In regression models, housing and transportation insecurity most frequently emerged as significant variables associated with lower QoL subscores even after adjusting for patient demographics. Burden scores showed the largest effect sizes (housing instability β =-17.90, P < 0.001, transportation problems β =-14.03, P = 0.001). CONCLUSION: HRSN is significantly associated with lower QoL scores, with largest effect sizes seen with housing instability and transportation problems. Increased screening and intervention for HRSN may improve QoL among people on hemodialysis.

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