Social deprivation reduced registration for kidney transplantation through markers of nephrological care: a mediation analysis

Abstract

ObjectivesWe assessed the direct and indirect effect of social deprivation mediated by modifiable markers of nephrological follow-up on registration on the renal transplantation waiting-list. Study Design and SettingsFrom the Renal Epidemiology and Information Network, we included French incident dialysis patients eligible for a registration evaluation between January 2017 and June 2018. Mediation analyses were conducted to assess effects of social deprivation estimated by quintile 5 (Q5) of the European Deprivation Index on registration defined as wait-listing at dialysis start or within the first 6 months. ResultsAmong the 11,655 included patients, 2,410 were registered. The Q5 had a direct effect on registration (odds ratio [OR]: 0.82 [0.80–0.84]) and an indirect effect mediated by emergency start dialysis (OR: 0.97 [0.97–0.98]), hemoglobin <11 g/dL and/or lack of erythropoietin (OR 0.96 [0.96–0.96]) and albumin <30 g/L (OR: 0.98 [0.98–0.99]). ConclusionSocial deprivation was directly associated with a lower registration on the renal transplantation waiting-list but its effect was also mediated by markers of nephrological care, suggesting that improving the follow-up of the most deprived patients should help to reduce disparities in access to transplantation.