Effect of social deprivation on peritoneal dialysis uptake: A mediation analysis with the data of the REIN registry

Abstract

Background: Social deprivation could act as a barrier to peritoneal dialysis (PD). The objective of this study was to assess the association between social deprivation estimated by the European deprivation index (EDI) and PD uptake and to explore the potential mediators of this association. Methods: From the Renal Epidemiology and Information Network registry, patients who started dialysis in 2017 were included. The EDI was calculated based on the patient’s address. The event of interest was the proportion of PD 3 months after dialysis initiation. A mediation analysis with a counterfactual approach was carried out to evaluate the direct and indirect effect of the EDI on the proportion of PD. Results: Among the 9588 patients included, 1116 patients were on PD; 2894 (30.2%) patients belonged to the most deprived quintile (Q5). PD was associated with age >70 years (odds ratio (OR) 0.79 [95% confidence interval (CI): 0.69–0.91]), male gender (0.85 [95% CI: 0.74–0.97]), cardiovascular disease (OR 0.86 [95% CI: 0.86–1.00]), chronic heart failure (OR 1.34 [95% CI: 1.13–1.58]), active cancer (OR 0.67 [95% CI: 0.53–0.85]) and obesity (OR 0.75 [95% CI: 0.63–0.89]). In the mediation analysis, Q5 had a direct effect on PD proportion OR 0.84 [95% CI: 0.73–0.96]. The effect of Q5 on the proportion of PD was mediated by haemoglobin level at dialysis initiation (OR 0.96 [95% CI: 0.94–0.98]) and emergency start (OR 0.98 [95% CI: 0.96–0.99]). Conclusion: Social deprivation, estimated by the EDI, was associated with a lower PD uptake. The effect of social deprivation was mediated by haemoglobin level, a proxy of predialysis care and emergency start.

What are the factors that determine treatment choices in patients with kidney failure: a retrospective cohort study using data linkage of routinely collected data in Wales

“…Although previous studies have shown potential links between factors such as deprivation and travel time to units as a predictor of choice,2 34 35 our multivariate analysis did not show this. However, we did see very clear (and predictable) indicators of discussions towards MCM and transplant, for example, discussions of MCM increased with age and frailty.…”

Social Deprivation Is Associated With Lower Access to Pre-emptive Kidney Transplantation and More Urgent-Start Dialysis in the Pediatric Population

“…It has been found that geographic clusters of municipalities at high risk of urgent start of dialysis in adults were actually less urbanized and had lower sociodemographic background than areas at lower risk. 34 In 3 other studies also using EDI, social deprivation was associated with a lower PD uptake 35 and a decreased access to pre-emptive kidney transplant 36 ; the most deprived adults were less likely to be on self-care dialysis. 37 …”

Sex disparities in the utilization of nurse-assisted peritoneal dialysis: a mediation analysis using data from the REIN registry

“…In two previous studies, women were more likely to be treated by PD than HD compared with men [ 1 , 17 ]. Among the patients treated by PD, there was no difference between men and women in PD modality (CAPD, APD) [ 4 ].…”

“…Social deprivation was a mediator of the sex effect on the utilization of nurse-assisted PD, in France, women are more exposed to social deprivation than men. In two studies the chance of being treated by self-care dialysis was lower among socially deprived patients [ 9 , 17 ]. Social deprivation is associated with lower access to the healthcare system [ 34 ], which could affect access to predialysis clinics and jeopardize patient education and training for self-care dialysis.…”