Due to the effect of increased sodium consumption on blood pressure, volume overload and progression of chronic kidney disease (CKD), various guidelines, such as the Kidney Disease Quality Outcomes Initiative (KDOQI), recommend decreased sodium intake in patients suffering from CKD. However, many pediatric patients fail to adhere to these recommendations. Socioeconomic disparities in populations unable to afford or access high quality food may contribute.
We sought to determine the relationship between dietary quality and various socioeconomic factors including race, ethnicity, income, and residence in a pediatric CKD patient population.
The Chronic Kidney Disease in Children (CKiD) study is a multicenter prospective cohort study of 891 children aged 1-16 with estimated GFR (eGFR) of 30-90ml/min/1.73m2, 578 of which contained census data. In 536 participants, a Food Frequency Questionnaire (FFQ) adopted and modified from Harvard Services FFQ was used to assess daily caloric intake, sodium consumption, as well as added sugar and fat intake. Patients without FFQ data and individuals under the age of 2 were excluded. Residence data was assessed by merging the USDA dataset, which assesses distance to supermarkets, to determine if the patient was residing in a food desert and its possible effect on dietary quality. Continuous variables were assessed for significance with Kruskal Wallis Tests and categorical variables were assessed with Fisher exact tests.
We compared subject characteristics across strata of key dietary variables, including sodium and added sugar intake. Roughly one fourth (24.3%) of the patient population was found to adhere to age-based sodium recommendation. Most patients (48.9%) consumed 1-2X the recommended sodium per their age group while the proportions consuming 2-3 X and greater than 3 X the recommended sodium encompassed 17.1% and 9.7%, respectively. Significant findings included increased proportion (49.0%) of lower income patients representing those consuming greater than 3x recommended sodium compared to the recommended sodium intake group (32.8%). (p= 0.038) The proportion of lower income patients in the 2-3X tier was also increased (42.2%) but was not significant. The results also showed a nonsignificant increase of proportion of African American and Hispanic patients exceeding recommended sodium guidelines. Residence in a food desert did not seem to affect dietary quality. Decreased age and male gender were also associated with decreased adherence to recommended sodium guidelines. Similar analysis was performed assessing fat and added sugar intake without significant results.
We found lower income associated with increased sodium intake in lower income families who do not have access to healthier options. Targeted interventions in this population may improve adherence to dietary recommendations.
