{
  "abstract": "Objectives\n\nTo examine how maintenance in-center hemodialysis redistributes unpaid labor, financial strain, and emotional responsibility within low-income Delaware households.Methods\n\nAfter background review and survey development from October 2025 through April 2026, a cross-sectional mixed-methods survey was administered during July-August 2026 in greater Wilmington, Delaware. Participants were 48 adult unpaid family caregivers of adults receiving maintenance in-center hemodialysis from low-income households. Recruitment used remote and community-based kidney-care channels, including MayaMD, a virtual nephrology care company, Wilmington-area community health organizations, and clinical social-worker flyers. Quantitative items assessed caregiving time, household effects, resource insecurity, and perceived burden; open-ended responses were analyzed thematically.Results\n\nCaregivers reported a mean of 28.7 hours of kidney-related care weekly. Transportation and waiting accounted for the largest share of time. Sixty-nine percent missed work or school, 63% changed household food purchases, 50% delayed their own health care, 46% reported food insecurity, 27% lacked reliable private transportation, 65% reported moderate or high financial strain, and 58% reported moderate or high emotional strain. Open-ended responses showed that caregivers experienced dialysis not only as a treatment schedule but as a household system of work, obligation, rationing, and role negotiation.Conclusions\n\nDialysis treatment in low-income households depends on unpaid family infrastructure that is clinically necessary but insufficiently measured. Low-income caregivers did not merely assist care; they absorbed transportation, food, employment, and emotional costs that shaped treatment continuity.Policy implications\n\nDelaware dialysis and public health systems should treat caregivers as part of chronic-disease infrastructure by screening for strain and coordinating transportation, nutrition, social-work, employment, and respite supports.",
  "abstract_shown": true,
  "affiliations": [
    "Student Intern, MayaMD."
  ],
  "article_type": "discussion",
  "arxiv": null,
  "author_total": 1,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Avi Kapoor"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7wz4ec3t2bkkt.bib",
  "cited_by": 0,
  "doi": "10.32481/djph.2026.10.13",
  "fulltext_url": "https://europepmc.org/articles/PMC13712914",
  "id": "7wz4ec3t2bkkt",
  "issns": [
    "2639-6378"
  ],
  "landing_url": "https://europepmc.org/article/MED/42948830",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Research Article"
    ],
    [
      "openalex",
      "2727|Dialysis and Renal Disease Management"
    ]
  ],
  "openalex": "W7223883999",
  "pdf_url": "https://europepmc.org/articles/PMC13712914?pdf=render",
  "pmcid": "PMC13712914",
  "pmid": "42948830",
  "published": "2026-10-26",
  "publisher": "Delaware Academy of Medicine and Public Health",
  "ris": "https://research.draconitic.com/paper/7wz4ec3t2bkkt.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T00:20:34Z",
      "native_id": "MED:42948830",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42948830"
    },
    {
      "first_seen": "2026-10-31T12:23:24Z",
      "native_id": "PMC13712914",
      "source": "pmc",
      "url": "https://doi.org/10.32481/djph.2026.10.13"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2727|Dialysis and Renal Disease Management",
      "subfield": "general"
    }
  ],
  "title": "The Household as Dialysis Infrastructure : Family Caregiving, Poverty, and In-Center Hemodialysis in Delaware.",
  "title_text": "The Household as Dialysis Infrastructure : Family Caregiving, Poverty, and In-Center Hemodialysis in Delaware.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T12:23:24Z",
  "url": "https://research.draconitic.com/paper/7wz4ec3t2bkkt",
  "venue": "Delaware journal of public health",
  "versions": []
}