ORIGINAL RESEARCH article
Front. Health Serv.
Sec. Patient Centered Health Systems
Cognitive, Functional, and Social Disparities in Patients Receiving Dialysis: A multi-site survey
Provisionally accepted
- 1Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, United States
- 2Psychology Department, Palo Alto University, Palo Alto, United States
- 3Clinical Psychology Department, Notre Dame de Namur University, Belmont, United States
- 4Stanford University School of Medicine, Stanford, United States
- 5Department of Cell and Molecular Biology, University of Hawai'i at Manoa John A Burns School of Medicine, Honolulu, United States
- 6DaVita Inc, Denver, United States
- 7Harvard Medical School Center for Bioethics, Boston, United States
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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. Objective: 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. Methods: 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. Results: From our large sample, 41.0% reported memory challenges, 19.6% required assistance with activities of daily living (ADLs), and 65.0% experienced mobility limitations. Additionally, 20.4% reported difficulty accessing healthcare, while 16.3% faced challenges obtaining medications. A subset (7.4%) of participants experienced overlapping social, cognitive, and functional barriers. Unmet needs were disproportionately higher amongst Medicaid and dual-eligible Medicare/Medicaid participants compared to those with private insurance, with 25.0% of dual-eligible participants reporting two or more unmet needs. Conclusions: 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.
Keywords: cognitive dysfunction, End stage kidney disease (ESKD), functional mobility, health equity, Kidney care, patient centered care, social needs
Received: 19 Aug 2025; Accepted: 15 Dec 2025.
Copyright: © 2025 Liou-Johnson, Narayan, Johnson, Shah and Odama. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Victoria Liou-Johnson
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