Association of Deprivation with Worse Outcomes in Chronic Kidney Disease: Findings from a Hospital-Based Cohort in the United Kingdom

Abstract

Background: Chronic kidney disease (CKD) prevalence and complications are known to be associated with deprivation, but there is limited understanding of the underlying reasons for inequalities. Aims: To evaluate the association of both individual and area level socioeconomic status (SES) with heavy proteinuria at presentation, progression of CKD, end-stage renal disease (ESRD) and death. Methods: A retrospective study of 918 CKD patients using integral multivariate logistic regression to adjust for known clinical and demographic explanatory variables. Results: During 3 years of median follow-up, 34% of the study population had progression of their CKD and of these, 32% experienced rapid progression. 23% presented with heavy proteinuria (urine protein:creatinine ratio ≥300 mg/mmol), 4% developed ESRD requiring renal replacement therapy and 10% died. Area level deprivation was independently associated with heavy proteinuria, progression and rapid progression of CKD. People living in the most deprived areas were more likely to develop ESRD. Unskilled professionals were more likely to experience a higher mortality rate. Conclusion: Area level SES is inversely associated with both heavy proteinuria on presentation and progression as well as rapid progression of CKD. In contrast, individual level SES, unskilled professionals found to have a marginally significant association with increased risk of mortality. People living in more deprived areas presenting with CKD are likely to be at increased risk of poor outcomes and may need more active management and earlier referral.