The impact of socioeconomic status and geographic remoteness on access to pre-emptive kidney transplantation and transplant outcomes among children

Francis, Anna; Didsbury, Madeleine; Lim, Wai H.; Kim, Siah; White, Sarah L.; Craig, Jonathan C.; Wong, Germaine

doi:10.1007/s00467-015-3279-z

Cited by 35 publications

(33 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The association between access to specialist kidney care is, however, inconsistent. Our study found no association between socioeconomic deprivation and late presentation, which correlates with unadjusted findings from another study (21). As UK health care coverage is universal and free at the point of delivery, this finding is reassuring and suggests deprivation is not implicated in the pathway to diagnosis: from identification and appraisal of symptoms, seeking health care review to subsequent diagnosis.…”

Section: Discussionsupporting

confidence: 81%

“…In addition, the association between socioeconomic deprivation and distance differs across countries. In the United Kingdom, higher proportions of affluent children lived remotely, whereas for Australian children, the inverse is true (21). Living in an urban location was not associated with either late presentation or pre-emptive transplantation.…”

Section: Discussionmentioning

confidence: 84%

See 1 more Smart Citation

Associations between Deprivation, Geographic Location, and Access to Pediatric Kidney Care in the United Kingdom

Plumb

Sinha

Casula

et al. 2021

CJASN

View full text Add to dashboard Cite

Background and objectivesPre-emptive kidney transplantation is advocated as best practice for children with kidney failure who are transplant eligible; however, it is limited by late presentation. We aimed to determine whether socioeconomic deprivation and/or geographic location (distance to the center and rural/urban residence) are associated with late presentation, and to what degree these factors could explain differences in accessing pre-emptive transplantation.Design, setting, participants, & measurementsA cohort study using prospectively collected United Kingdom Renal Registry and National Health Service Blood and Transplant data from January 1, 1996 to December 31, 2016 was performed. We included children aged >3 months to ≤16 years at the start of KRT. Multivariable logistic regression models were used to determine associations between the above exposures and our outcomes: late presentation (defined as starting KRT within 90 days of first nephrology review) and pre-emptive transplantation, with a priori specified covariates.ResultsAnalysis was performed on 2160 children (41% females), with a median age of 3.8 years (interquartile range, 0.2–9.9 years) at first nephrology review. Excluding missing data, 478 were late presenters (24%); 565 (26%) underwent pre-emptive transplantation, none of whom were late presenting. No association was seen between distance or socioeconomic deprivation with late presentation, in crude or adjusted analyses. Excluding late presenters, greater area affluence was associated with higher odds of pre-emptive transplantation, (odds ratio, 1.20 per quintile greater affluence; 95% confidence interval, 1.10 to 1.31), with children of South Asian (odds ratio, 0.52; 95% confidence interval, 0.36 to 0.76) or Black ethnicity (odds ratio, 0.31; 95% confidence interval, 0.12 to 0.80) less likely to receive one. A longer distance to the center was associated with pre-emptive transplantation on crude analyses; however, this relationship was attenuated (odds ratio, 1.02 per 10 km; 95% confidence interval, 0.99 to 1.05) in the multivariable model.ConclusionsSocioeconomic deprivation or geographic location are not associated with late presentation in children in the United Kingdom. Geographic location was not independently associated with pre-emptive transplantation; however, children from more affluent areas were more likely to receive a pre-emptive transplant.

show abstract

Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 84%

Associations between Deprivation, Geographic Location, and Access to Pediatric Kidney Care in the United Kingdom

Plumb

Sinha

Casula

et al. 2021

CJASN

View full text Add to dashboard Cite

show abstract

“…Authors of a previous study conducted in Australia found that remoteness had an impact on receiving a preemptive transplant, but no association between socioeconomic status and transplant outcome has been shown. 17 Moreover, authors of another pediatric study in Nicaragua found a significant association between deprivation and mortality rate among patients undergoing dialysis. 14 Most of the data are thus consistent across countries, despite different health care systems.…”

Section: Discussionmentioning

confidence: 99%

Social deprivation is associated with poor kidney transplantation outcome in children

Driollet

Bayer

Châtelet

et al. 2019

Kidney International

View full text Add to dashboard Cite

“…Paediatric nephrology services, especially maintenance dialysis, are very limited in India, forcing families to travel long distances to access care 9 . Greater distance from transplant centres increases the risk of mortality 22 and is a barrier to achieving transplantation in both children and adults 23,24 Parental refusal of transplant …”

Section: Discussionmentioning

confidence: 99%

Low renal transplantation rates in children with end‐stage kidney disease: A study of barriers in a low‐resource setting

Pais

Blydt‐Hansen

Raj

et al. 2020

Pediatric Transplantation

View full text Add to dashboard Cite

After 2 decades as a low‐cost transplant centre in India, our rates of kidney transplantation are low compared to the burden of end‐stage kidney disease (ESKD). We performed this study to identify possible barriers inhibiting paediatric kidney transplant and to assess the outcomes of paediatric ESKD. A retrospective chart review of ESKD patients (2013 ‐ 2018) at a tertiary paediatric nephrology centre was conducted. Medical/non‐medical barriers to transplant were noted. Patient outcomes were classified as “continued treatment,” “lost to follow‐up (LTFU)” or “died.” Of 155 ESKD patients (monthly income 218 USD [146, 365], 94% self‐pay), only 30 (19%) were transplanted (28 living donor). Sixty‐five (42%) were LTFU, 19 (12%) died, and 71 (46%) continued treatment. LTFU/death was associated with greater travel distance (300 km [60, 400] vs 110 km [20, 250] km, P < .0001) and lower monthly income (145 USD [101, 290] vs 290 USD [159, 681], P < .0001). Among those who continued treatment, 41 proceeded to transplant evaluation of whom 13 had no living donor and remained waitlisted for 27 months (15, 30). The remainder (n = 30) did not proceed to transplant due to unresolved medical issues (n = 10) or a lack of parental interest in pursuing transplant (n = 20). Barriers to transplantation in low‐resource setting begin in ESKD. LTFU resulted in withdrawal of care and was associated with low socioeconomic status. Among those who continued treatment, transplant rates were higher but medical challenges and negative attitudes towards transplant and organ donation occurred.

show abstract

The impact of socioeconomic status and geographic remoteness on access to pre-emptive kidney transplantation and transplant outcomes among children

Cited by 35 publications

References 44 publications

Associations between Deprivation, Geographic Location, and Access to Pediatric Kidney Care in the United Kingdom

Associations between Deprivation, Geographic Location, and Access to Pediatric Kidney Care in the United Kingdom

Social deprivation is associated with poor kidney transplantation outcome in children

Low renal transplantation rates in children with end‐stage kidney disease: A study of barriers in a low‐resource setting

Contact Info

Product

Resources

About