Is self-care dialysis associated with social deprivation in a universal health care system? A cohort study with data from the Renal Epidemiology and Information Network Registry

Beaumier, Mathilde; Béchade, Clémence; Dejardin, Olivier; Lassalle, Mathilde; Vigneau, Cécile; Longlune, Nathalie; Launay, Ludivine; Couchoud, Cécile; Ficheux, Maxence; Lobbedez, Thierry; Châtelet, Valérie

doi:10.1093/ndt/gfz245

Cited by 13 publications

(10 citation statements)

References 39 publications

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“…24 The EDI allows for comparison between European countries, where it has been validated 25 and has already been used in the nephrology field. 19,26,27 There are factors associated with poverty that could affect PD utilization, such as patient education or access to the healthcare system, which could be modified. Haemoglobin level at dialysis initiation, a proxy of the predialysis care, and starting dialysis in an unplanned manner, which have been described as factors associated with a lower utilization of PD, may explain the association between social deprivation and PD uptake.…”

Section: Introductionmentioning

confidence: 99%

“…It has been shown that SES was associated with dialysis modality in Australia, Canada, the United Kingdom, France, and the United States. 10,[16][17][18][19][20] Whether social deprivation could act as a barrier to PD utilization is a matter of concern. Access to the healthcare system, education, and comorbidities linked to social deprivation may influence a lower rate of PD uptake in the most deprived individuals.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…32 In three other studies also using EDI, social deprivation was associated with a lower peritoneal dialysis uptake 33 and with a decreased access to pre-emptive kidney transplant 34 , the most deprived adults were less likely to be on self-care dialysis. 35 One of our main findings is that children who were living in a more deprived area were more likely to initiate KRT with dialysis, with a clear social gradient. These results raise questions about the barriers leading to social inequality since pre-emptive kidney transplantation has been shown to improve kidney transplant outcomes.…”

Section: Discussionmentioning

confidence: 79%

“… 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 …”

Section: Discussionmentioning

confidence: 99%

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

Driollet

Bayer

Kwon

et al. 2022

Kidney International Reports

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…Our findings were consistent with the results of previous studies, which highlighted social disparities in access to preemptive transplantation [9][10][11][12] and confirmed that the EDI can be used in the nephrology field of social deprivation. 12,[16][17][18]25,26 The factors that may explain this association could depend on the healthcare system, the recipient, and the donor, as well as the physician.…”

Section: Discussionmentioning

confidence: 99%

Effects of Social Deprivation on the Proportion of Preemptive Kidney Transplantation: A Mediation Analysis

Calvar

Launay

Boyer

et al. 2021

Transplantation Direct

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I t is widely accepted that, compared with dialysis, renal transplantation is associated with a lower risk of mortality and a greater quality of life. 1 Large-scale studies have demonstrated that patients transplanted before beginning dialysis had a lower risk of death than subjects who were transplanted while on dialysis. 2,3 Furthermore, it has been shown that the time spent on dialysis before transplantation affects patient survival. 3 The beneficial effect of preemptive transplantation on renal allograft survival is more controversial. 4 Nevertheless, longer transplant survival was found when transplantation was performed from a living donor 5-7 and when living-donor transplantation was performed preemptively rather than after the initiation of dialysis. 7 Recent recommendations encourage preemptive living-donor kidney transplantation (LDKT). 8 On the other hand, it has been demonstrated that there are social inequalities in access to preemptive renal transplantation. [9][10][11] In France, it has been suggested that social deprivation could influence access to preemptive registration. 12 There is a lack of data regarding the underlying mechanism by which social deprivation affects preemptive renal transplantation. Decreased access to living-donor transplantation of the most deprived population may partially explain this social inequity. 9,10,13 The European Deprivation Index (EDI) is a composite index that measures social deprivation. It contains variables common, on the one hand, to the European Union Statistics on Income and Living survey that studied objective poverty and the concept of individual perception of needs called "subjective poverty" in 26 European countries 14 and, on the other hand, Background. Social inequalities in health lead to an increased risk of chronic kidney disease and less access to renal transplantation. The objective of this study was to assess the association between social deprivation estimated by the fifth quintile of the European Deprivation Index (EDI) and preemptive kidney transplantation (PKT) and to explore the potential mediators of this association. Methods. This retrospective observational multicenter study included 8701 patients who received their first renal transplant in France between 2010 and 2014. Mediation analyses were performed to assess the direct and indirect effects of the EDI on PKT. Results. Among the 8701 transplant recipients, 32.4% belonged to the most deprived quintile of the EDI (quintile 5) and 16% received a PKT (performed either with a deceased-or living-donor). There was a significant association between quintile 5 of the EDI and PKT (total effect: odds ratio [OR]: 0.64 [95% confidence interval (CI): 0.55-0.73]). Living-donor kidney transplantation was the main mediator of this association (natural indirect effect: OR: 0.92 [0.89-0.95]). To a lesser extent, positive cytomegalovirus and hepatitis C serologies and blood group B were also mediators (respective natural indirect effects: OR: 0.98 [95% CI: 0.95-1.00], OR: 0.99 [95% CI: 0.99-1.00], and ...

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Is self-care dialysis associated with social deprivation in a universal health care system? A cohort study with data from the Renal Epidemiology and Information Network Registry

Cited by 13 publications

References 39 publications

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

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

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

Effects of Social Deprivation on the Proportion of Preemptive Kidney Transplantation: A Mediation Analysis

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