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

Driollet, Bénédicte; Bayer, Florian; Kwon, Thérèsa; Krid, Saoussen; Ranchin, Bruno; Tsimaratos, Michel; Parmentier, Cyrielle; Novo, Robert; Roussey, G.; Tellier, Stéphanie; Fila, Marc; Zaloszyc, Ariane; Godron-Dubrasquet, Astrid; Cloarec, Sylvie; Vrillon, Isabelle; Broux, Françoise; Bérard, Étienne; Taque, Sophie; Piètrement, Christine; Nobili, François; Guigonis, Vincent; Launay, Ludivine; Couchoud, Cécile; Harambat, Jérôme; Leffondré, Karen

doi:10.1016/j.ekir.2021.12.015

Cited by 19 publications

(18 citation statements)

References 45 publications

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“…PD is often selected as the initial KRT modality in the paediatric population, usually as a bridge to transplantation 208 . Urgent start of PD for AKI is also often used in children, especially in low-resource regions, as this may be the only form of dialysis available 209 . PD was leveraged as a KRT modality for paediatric AKI, more commonly in LMICs than in HICs.…”

Section: Pd Outcomes In Vulnerable Populationsmentioning

confidence: 99%

Epidemiology of peritoneal dialysis outcomes

et al. 2022

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Peritoneal dialysis (PD) is an important home-based treatment for kidney failure and accounts for 11% of all dialysis and 9% of all kidney replacement therapy globally. Although PD is available in 81% of countries, this provision ranges from 96% in high-income countries to 32% in low-income countries. Compared with haemodialysis, PD has numerous potential advantages, including a simpler technique, greater feasibility of use in remote communities, generally lower cost, lesser need for trained staff, fewer management challenges during natural disasters, possibly better survival in the first few years, greater ability to travel, fewer dietary restrictions, better preservation of residual kidney function, greater treatment satisfaction, better quality of life, better outcomes following subsequent kidney transplantation, delayed need for vascular access (especially in small children), reduced need for erythropoiesis-stimulating agents, and lower risk of blood-borne virus infections and of SARS-CoV-2 infection. PD outcomes have been improving over time but with great variability, driven by individual and system-level inequities and by centre effects; this variation is exacerbated by a lack of standardized outcome definitions. Potential strategies for outcome improvement include enhanced standardization, monitoring and reporting of PD outcomes, and the implementation of continuous quality improvement programmes and of PD-specific interventions, such as incremental PD, the use of biocompatible PD solutions and remote PD monitoring.

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Section: Pd Outcomes In Vulnerable Populationsmentioning

confidence: 99%

Epidemiology of peritoneal dialysis outcomes

et al. 2022

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“…These findings from Driollet et al. 9 add to a growing body of evidence concerning unacceptable socioeconomic inequities in kidney care and outcomes for young people with CKD. They reinforce the critical role that the nephology community has to play as actors and advocates for improvements to the conditions in which patients with CKD live, learn, play, and work, to ensure that all young people with CKD have the opportunity to flourish across the life course.…”

mentioning

confidence: 66%

“…This study 9 represents an important addition to the literature on socioeconomic inequities in health for children with CKD, with clear relevance to other high-income countries with universal health care. Key strengths include use of a validated SEP index, consideration of multiple important outcomes, and use of a comprehensive national registry.…”

mentioning

confidence: 95%

“…This issue of KI Reports includes an important study from Driollet et al. 9 examining associations between area-level social disadvantage and quality of care at KRT initiation, among 1115 young people initiating KRT before 20 years of age in metropolitan France. Using data from a comprehensive national registry, outcomes included initial KRT modality (dialysis vs. pre-emptive transplantation) and pre-emptive registration on the transplant waiting list, including initial modality (hemodialysis vs. peritoneal dialysis) and urgent initiation for patients initiating on dialysis.…”

mentioning

confidence: 99%

“…The present findings are particularly striking given that France has a highly comprehensive universal health care system for patients with long-term conditions, which may be expected to attenuate socioeconomic inequities in kidney care. 9 Yet, even with comprehensive financial coverage, patients experiencing SEP disadvantage may still experience numerous barriers to quality care, including material and psychosocial factors. For example, urgent start dialysis may reflect barriers to health care earlier in the CKD journey including reduced health literacy and logistical constraints such as transport, resulting in delayed CKD diagnosis and specialty referral and reduced prevention and identification of CKD progression.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Tackling Health Inequities for Children and Adolescents With CKD—A Call to Advocacy and Action Across the Life Course

Zwieten

Wong

Qader

2022

Kidney International Reports

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Racial Equity in Living Donor Kidney Transplant Centers, 2008-2018

McElroy,

Schappe,

Mohottige

et al. 2023

JAMA Netw Open

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ImportanceIt is unclear whether center-level factors are associated with racial equity in living donor kidney transplant (LDKT).ObjectiveTo evaluate center-level factors and racial equity in LDKT during an 11-year time period.Design, Setting, and ParticipantsA retrospective cohort longitudinal study was completed in February 2023, of US transplant centers with at least 12 annual LDKTs from January 1, 2008, to December 31, 2018, identified in the Health Resources Services Administration database and linked to the US Renal Data System and the Scientific Registry of Transplant Recipients.Main Outcomes and MeasuresObserved and model-based estimated Black-White mean LDKT rate ratios (RRs), where an RR of 1 indicates racial equity and values less than 1 indicate a lower rate of LDKT of Black patients compared with White patients. Estimated yearly best-case center-specific LDKT RRs between Black and White individuals, where modifiable center characteristics were set to values that would facilitate access to LDKT.ResultsThe final cohorts of patients included 394 625 waitlisted adults, of whom 33.1% were Black and 66.9% were White, and 57 222 adult LDKT recipients, of whom 14.1% were Black and 85.9% were White. Among 89 transplant centers, estimated yearly center-level RRs between Black and White individuals accounting for center and population characteristics ranged from 0.0557 in 2008 to 0.771 in 2018. The yearly median RRs ranged from 0.216 in 2016 to 0.285 in 2010. Model-based estimations for the hypothetical best-case scenario resulted in little change in the minimum RR (from 0.0557 to 0.0549), but a greater positive shift in the maximum RR from 0.771 to 0.895. Relative to the observed 582 LDKT in Black patients and 3837 in White patients, the 2018 hypothetical model estimated an increase of 423 (a 72.7% increase) LDKTs for Black patients and of 1838 (a 47.9% increase) LDKTs for White patients.Conclusions and RelevanceIn this cohort study of patients with kidney failure, no substantial improvement occurred over time either in the observed or the covariate-adjusted estimated RRs. Under the best-case hypothetical estimations, modifying centers’ participation in the paired exchange and voucher programs and increased access to public insurance may contribute to improved racial equity in LDKT. Additional work is needed to identify center-level and program-specific strategies to improve racial equity in access to LDKT.

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

Cited by 19 publications

References 45 publications

Epidemiology of peritoneal dialysis outcomes

Epidemiology of peritoneal dialysis outcomes

Tackling Health Inequities for Children and Adolescents With CKD—A Call to Advocacy and Action Across the Life Course

Racial Equity in Living Donor Kidney Transplant Centers, 2008-2018

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