Homelessness linked to end-stage renal failure, death among veterans with chronic kidney disease

For veterans with chronic kidney disease (CKD), a history of homelessness is associated with an increased risk of end-stage renal disease (ESKD) and death, according to a study published online Sept. 10 in JAMA network opened.

Alain K. Koyama, Sc.D., of the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues examined the association between a history of homelessness and the risk of ESKD and death in a retrospective cohort study among veterans with stage 3 to 5 CKD. Data from 836,361 veterans were included: 32.8% and 32.4% were 65 to 74 and 75 to 84 years of age, respectively.

The researchers found that 3.1% of veterans developed ESKD and 43.0% died from it. Veterans with a history of homelessness had a significantly higher risk of ESKD than those who had not experienced homelessness (adjusted hazard ratio [aHR]1.15; 95% confidence interval [CI]1.10 to 1.20). They also had a higher risk of death from any cause (aHR, 1.48; 95% CI, 1.46 to 1.50).

The results were attenuated but remained significant for all causes of death (aHR 1.09; 95% CI 1.07 to 1.11) and were no longer statistically significant for ESKD after further adjustment for body mass index, comorbidities, and medication use (aHR 1.04; 95% CI 0.99 to 1.09).

“Potential interventions to improve CKD care could include tailored measures to improve access to care for this population,” the authors write. “Long-term solutions may require recognizing housing as a primary determinant of health and prioritizing housing to ensure appropriate treatment for CKD and other chronic conditions.”

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