Chronic kidney disease in migrant and non-migrant populations: data from an Italian regional project

Abstract

Abstract Background The proportion of migrants among incident patients with chronic kidney disease (CKD) in the Emilia-Romagna region is steadily increasing. Inequalities in access to health services and in outcomes between non-migrant and migrant patients already known in the literature are found also for those affected by CKD. We compared migrants' groups and Italian patients to provide evidence which may be useful to public health professionals and nephrologists for migrant patients' management. Methods Italian and migrant patients followed up in PIRP (a regional project devised to delay progression to kidney failure in subjects with CKD) were identified. Migrants were grouped by geographical area of origin and compared to Italians by means of descriptive statistics and survival analysis. Results As of 30.4.2020, migrants account for 3.1% (n = 955/30523) of all PIRP patients and 4.2% (n = 481/11335) of prevalent patients; their proportion among incident patients grew from 1.0% in 2004 to 5.5% in 2019. All areas of origin were adequately represented, from 6.4% of East Asia to 26.1% of East Europe. Wide differences were found for: age at first visit (Italians=73.1 years vs. Sub-Saharians=47.7), proportion of males (75.0% for South Asians to 49.6% of East Europeans), diabetes (from 45.1% in East Asians to 19.4% in Sub-Saharians), comorbidities and type of nephropathy. Italians had the smallest median annual eGFR decrease (-1.0 ml/min), while the largest were found in migrants from East Asia (-2.2) and Arab States (-2.5). 5-year survival to renal death (dialysis or transplantation) was lower in South Asians (51.4%) than in Latino-Americans (85.3%) and Italians (85.0%). Conclusions Migrant chronic kidney disease patients have widely different features and outcomes compared to non-migrants and among migrant subgroups. Our findings pave the way to further investigation, whose results may be essential to tailor surveillance and treatment programs on specific groups of migrants. Key messages Among chronic kidney disease patients, non-migrants and migrants exhibit different clinical characteristics and outcomes, and thus require different surveillance and treatment approaches. Future research should analyze the causes of disparities between migrant and non-migrant chronic kidney disease patients, specifically focusing on those related to inequalities in access to healthcare.