Social deprivation at initiation of kidney replacement therapy in the pediatric population

Abstract

Socioeconomic status is recognized as an important determinant of kidney health. We aimed to assess the association of social deprivation with different indicators at kidney replacement therapy (KRT) initiation in the French pediatric population. Data from the REIN registry. All end-stage kidney disease (ESKD) patients who started KRT before 20 years old in France between 2002 and 2015 were included. We investigated different indicators at KRT initiation: KRT modality (dialysis vs. pre-emptive transplantation), dialysis modality (hemodialysis [HD] vs. peritoneal dialysis [PD]), urgent vs. planned start of dialysis, use of catheter vs. fistula for HD vascular access, and late referral to a nephrologist. An ecological index, the European Deprivation Index (EDI), was used as a proxy for social deprivation. In total, 1115 patients were included (males 59%, median age at dialysis 14.4 years, glomerular/vascular diseases 36.8%). The most deprived group represented 38.7% of the patients, suggesting that pediatric ESKD patients come from a more socially deprived background. Social deprivation was significantly associated with the initial modality of KRT. Patients from the most deprived areas were more likely to initiate KRT with dialysis (adjusted OR: 1.88; 95% CI: 1.15–3.07) than those from the least deprived areas, and more often with HD than with PD. Among HD patients, the odds of starting treatment in emergency with a catheter was two-fold higher for the most deprived compared to the least deprived children (adjusted OR: 2.08; 95% CI: 1.07–4.04). There was a trend towards later referral in patients from the most deprived areas. Children from the most deprived areas have lower access to pre-emptive kidney transplantation, lower access to PD, have more urgent initiation of HD with a catheter, and tend to be later referred to a nephrologist.