The impact of rural status on pediatric chronic kidney disease

Abstract

Children and adolescents in rural areas with chronic kidney disease (CKD) face unique challenges related to accessing pediatric nephrology care. Challenges to obtaining care begin with living increased distances from pediatric health care centers. Recent trends of increasing centralization of pediatric care mean fewer locations have pediatric nephrology, inpatient, and intensive care services. In addition, access to care for rural populations expands beyond distance and encompasses domains of approachability, acceptability, availability and accommodation, affordability, and appropriateness. Furthermore, the current literature identifies additional barriers to care for rural patients that include limited resources, including finances, education, and community/neighborhood social resources. Rural pediatric kidney failure patients have barriers to kidney replacement therapy options that may be even more limited for rural pediatric kidney failure patients when compared to rural adults with kidney failure. This educational review identifies possible strategies to improve health systems for rural CKD patients and their families: (1) increasing rural patient and hospital/clinic representation and focus in research, (2) understanding and mediating gaps in the geographic distribution of the pediatric nephrology workforce, (3) introducing regionalization models for delivering pediatric nephrology care to geographic areas, and (4) employing telehealth to expand the geographic reach of services and reduce family time and travel burden.

Urban–rural health disparity among patients with chronic kidney disease: a cross-sectional community-based study from 2012 to 2019

“…Moreover, recent research has emphasised that rurality can pose unique challenges for paediatric nephrology patients worldwide, leading to barriers accessing kidney replacement therapy options. 43 This is exacerbated by the uneven distribution of paediatric nephrologists in under-resourced and rural areas. It also discusses the variable adoption of telehealth in different regions during the SARS-CoV-2 pandemic and clinicians’ perceptions of telemedicine in clinical encounters.…”