*Purpose: Long-term kidney graft survival may be affected by factors other than biologic, including social determinants of health. We examined the association of the use of SNAP (Supplemental Nutrition Assistance) benefits with kidney function, stress and nutrition intake in inner-city kidney transplant recipients.

*Methods: A face-to-face survey was administered to 31 randomly selected pts attending transplant clinic. It included the Stress and Social Support (SSS) survey as well as the Perceived Stress Scale (PSS). Nutrition intake was assessed using 24-hour recall and analyzed by ASA-24 software. All comparisons are by Chi square or t-test as appropriate.

*Results: There were 11 women (36%) and 20 men (65%), 22 Black (71%), 4 Hispanic (13%) and 5 other. Mean age was 55.2±1.9 yrs, time since transplant 63.9±14.1 mos. 24 (77%) reported income <$40K yearly income, with 12 (39%) <$20K. 12 (39%) reported receiving SNAP benefits. Pts who received SNAP (SNAP+) had no difference in income or employment rate from those who did not. SNAP+ had significantly worse kidney function (creatinine 2.17±0.24 vs 1.44±0.11 mg/dl, p=0.014) and eGFR (37.9±3.8 vs 53.7±2.5 ml/min, p=0.003), but did not differ for time since transplant, gender, race, BP, BMI, tacrolimus level or age. SNAP+ also were more likely to disagree with the statement “I feel I am in control of my health and it doesn’t control me” (33% vs 0%, p=0.017), to report never or almost never feeling confident about handling personal problems (50% vs 16%, p=0.018), and to be unable to control irritations in their lives (67% vs 16%, p=0.043, p=0.043). There was no difference in caloric or macronutrient intake, but SNAP+ ate less fiber (11.1±1.3 vs 16.7±1.8 gm, p=0.023) and fewer servings of fruits and vegetables (1.5±0.28 vs 3.75±0.85, p=0.021). When asked about missed medication they did not report more missed doses.

*Conclusions: In our patient population: 1. Pts who were receiving SNAP benefits had worse kidney function than those who did not despite similar time since transplant, tacrolimus level, income or employment status. 2. The observation that they ate less fiber and fewer servings of fruits and vegetables despite similar caloric intake should be investigated further as higher intake of fruit and vegetables has been associated with delayed progression of kidney disease in non-transplant pts. 3.They also reported feeling less control over their health and less ability to handle day to day stress which may impact graft function as well. 4. The exact cause of poorer graft function in SNAP recipients deserves further study, but the finding suggests that more intensive counseling both psychological and nutritional in SNAP recipients might help avoid loss of graft function.

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