Socioeconomic status and dialysis quality of care

Abstract

Aim Lower socioeconomic status (SES) has been associated with increased dialysis mortality. This study aimed to determine if the quality of care (QOC) delivered to dialysis patients varied by SES. Methods All non‐Indigenous adults commencing haemodialysis (HD) or peritoneal dialysis (PD) registered with the Australia and New Zealand Dialysis and Transplant Registry between 2002 and 2012 were included. Each patient's location at dialysis start was classified into SES quartiles of advantaged to disadvantaged. Guidelines were used to determine attainment of adequate QOC at 6–<18 months and 18–<30 months after dialysis start, using logistic regression models. QOC measures included pre‐dialysis phosphate, calcium, haemoglobin, transferrin saturation and ferritin. HD‐related parameters included single pool Kt/V and percentage with functioning arteriovenous fistula/graft. PD‐related parameters included weekly Kt/V and percentage transferring to HD. Results Of 19 486 commencing dialysis, the median age was 65 years (interquartile range 53–74), 62.2% were male and 85.1% were Caucasian. At 6–<18 months after dialysis start, there were no significant differences by SES in attainment of biochemical targets, PD or HD adequacy. The disadvantaged quartile was less likely to achieve haemoglobin targets (odds ratio 0.88, 0.80–0.96, P = 0.01) or have a functioning arteriovenous fistula or graft (odds ratio 0.79, 0.68–0.92, P = 0.003) compared with the most advantaged group. Vascular access differences persisted at 18–<30 months. Conclusion Other than vascular access, area‐level SES has minimal impact on QOC attainment among non‐Indigenous dialysis patients in Australia. Increased mortality in lower SES groups may be due to pre‐dialysis factors and other variables such as health‐related behaviours, lifestyle and literacy.

Health Insurance Status Is Related to Risk of Mortality and Hospitalization in Korean Maintenance Hemodialysis Patients: A Longitudinal Cohort Study

“…In our study, the MA recipient group demonstrated non-inferior results of clinical indicators compared to the NHI beneficiary group such as lower proportion of hypertension or diabetes, better nutritional status with higher serum albumin, or plasma hemoglobin. Our finding is similar to that found in the recent studies performed in Australia [21]. Krishnasamy et al [21] demonstrated in their article that low SES adversely affects dialysis survival in Australia [15], but SES had minimal impact on biochemical parameters or dialysis adequacy.…”

“…Our finding is similar to that found in the recent studies performed in Australia [21]. Krishnasamy et al [21] demonstrated in their article that low SES adversely affects dialysis survival in Australia [15], but SES had minimal impact on biochemical parameters or dialysis adequacy. They suggested that low SES may increase mortality due to predialysis factors and other variables such as health-related behaviors, lifestyle, and literacy.…”

Evaluation of Peritoneal Dialysis Health Literacy in Peritoneal Dialysis Patients

“…The results indicate that total health literacy does not differ signi cantly with age, gender, education level, and economic level, similar to the ndings of Krishnasamy et al (2020) on socioeconomic status and quality of dialysis care [10]. A possible reason is that most of the PD groups in our study are individuals living in urban areas, and they have relatively high knowledge levels and economic levels.…”

Dialysis Adequacy among Haemodialysis Patients in Eastern Mediterranean Region: A Systematic Review and Meta-Analysis

“…Individuals in Australia have shown that all patients have a KT/V of 1.3 and higher, which shows better results than the present study. This difference could be due to differences in the type of study, differences in sample size, and better services provided in the centers [23]. The different cut-off points used to determine optimal dialysis adequacy in different countries can be an important factor influencing dialysis adequacy, so that in older guides, especially in developing countries, especially in the EMRO, KT/V>1.2 defined as optimal dialysis adequacy but in developed countries KT / V >1.4 to 1.7 are considered as adequate dialysis adequacy [24,25].…”