Impact of Individual and Environmental Socioeconomic Status on Peritoneal Dialysis Outcomes: A Retrospective Multicenter Cohort Study

Abstract

ObjectivesWe aimed to explore the impacts of individual and environmental socioeconomic status (SES) on the outcome of peritoneal dialysis (PD) in regions with significant SES disparity, through a retrospective multicenter cohort in China.MethodsOverall, 2,171 incident patients from seven PD centers were included. Individual SES was evaluated from yearly household income per person and education level. Environmental SES was represented by regional gross domestic product (GDP) per capita and medical resources. Undeveloped regions were defined as those with regional GDP lower than the median. All-cause and cardiovascular death and initial peritonitis were recorded as outcome events.ResultsPoorer PD patients or those who lived in undeveloped areas were younger and less-educated and bore a heavier burden of medical expenses. They had lower hemoglobin and serum albumin at baseline. Low income independently predicted the highest risks for all-cause or cardiovascular death and initial peritonitis compared with medium and high income. The interaction effect between individual education and regional GDP was determined. In undeveloped regions, patients with an elementary school education or lower were at significantly higher risk for all-cause death but not cardiovascular death or initial peritonitis compared with those who attended high school or had a higher diploma. Regional GDP was not associated with any outcome events.ConclusionLow personal income independently influenced all-cause and cardiovascular death, and initial peritonitis in PD patients. Education level predicted all-cause death only for patients in undeveloped regions. For PD patients in these high risk situations, integrated care before dialysis and well-constructed PD training programs might be helpful.

The Associations between the Family Education and Mortality of Patients on Peritoneal Dialysis

“…The education level of a PD patient was not found to contribute to any outcome events, similar to our previous reports[3]. To our knowledge, this is the first study to offer insight into the impact of family members' education status on PD patient outcomes.…”

“…By multivariable Cox regression analysis ( Table 3 ), similar to our previous report[3], patient education level did not predict patient survival after adjusting for age, gender, BMI, presence of DM, CVD history, baseline albumin, hemoglobin, RRF, and family income, and using center size as a stratified factor to adjust for center effects. However, the highest education of family members was significantly associated with higher mortality.…”

Depression and Cognitive Impairment in Peritoneal Dialysis: A Multicenter Cross-sectional Study

“…Demographic and laboratory data for our participants were in accordance with general characteristics of the PD population in China, 37 with mean values as follows: age, 52.1 years; PD vintage, 26.5 months; BMI, 22.9 kg/m 2 ; hemoglobin level, 104.3 g/L;…”

Performance of the Modified Mini-Mental State Examination (3MS) in Assessing Specific Cognitive Function in Patients Undergoing Peritoneal Dialysis

“…The mean age, gender, dialysis duration and primary kidney diseases were not significantly different between participants included and excluded. The basic data of our participants was in accordance with the general characteristics of the PD population in China [16]. The mean ages were 51.3 years, and PD durations were 25.1 months.…”