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Cho Y, Cullis B, Ethier I, Htay H, Jha V, Arruebo S, Caskey FJ, Damster S, Donner JA, Levin A, Nangaku M, Saad S, Tonelli M, Ye F, Okpechi IG, Bello AK, Johnson DW. Global structures, practices, and tools for provision of chronic peritoneal dialysis. Nephrol Dial Transplant 2024; 39:ii18-ii25. [PMID: 39235200 DOI: 10.1093/ndt/gfae130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Worldwide, the uptake of peritoneal dialysis (PD) compared with hemodialysis remains limited. This study assessed organizational structures, availability, accessibility, affordability and quality of PD worldwide. METHODS This cross-sectional study relied on data from kidney registries as well as survey data from stakeholders (clinicians, policymakers and advocates for people living with kidney disease) from countries affiliated with the International Society of Nephrology (ISN) from July to September 2022. RESULTS Overall, 167 countries participated in the survey. PD was available in 79% of countries with a median global prevalence of 21.0 [interquartile range (IQR) 1.5-62.4] per million population (pmp). High-income countries (HICs) had an 80-fold higher prevalence of PD than low-income countries (LICs) (56.2 pmp vs 0.7 pmp). In 53% of countries, adults had greater PD access than children. Only 29% of countries used public funding (and free) reimbursement for PD with Oceania and South East Asia (6%), Africa (10%) and South Asia (14%) having the lowest proportions of countries in this category. Overall, the annual median cost of PD was US$18 959.2 (IQR US$10 891.4-US$31 013.8) with full private out-of-pocket payment in 4% of countries and the highest median cost in LICs (US$30 064.4) compared with other country income levels (e.g. HICs US$27 206.0). CONCLUSIONS Ongoing large gaps and variability in the availability, access and affordability of PD across countries and world regions were observed. Of note, there is significant inequity in access to PD by children and for people in LICs.
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Affiliation(s)
- Yeoungjee Cho
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Brett Cullis
- Department of Nephrology and Child Health, University of Cape Town, Cape Town, South Africa
| | - Isabelle Ethier
- Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India
| | - Silvia Arruebo
- The International Society of Nephrology, Brussels, Belgium
| | - Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jo-Ann Donner
- The International Society of Nephrology, Brussels, Belgium
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Syed Saad
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ikechi G Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Aminu K Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - David W Johnson
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Driollet B, Couchoud C, Bacchetta J, Boyer O, Hogan J, Morin D, Nobili F, Tsimaratos M, Bérard E, Bayer F, Launay L, Leffondré K, Harambat J. Social Deprivation and Incidence of Pediatric Kidney Failure in France. Kidney Int Rep 2024; 9:2269-2277. [PMID: 39081742 PMCID: PMC11284436 DOI: 10.1016/j.ekir.2024.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Approximately 8 per million children and young adults aged < 20 years initiate kidney replacement therapy (KRT) per year in France. We hypothesize that social deprivation could be a determinant of childhood-onset kidney failure. The objective of this study was to estimate the incidence of pediatric KRT in France according to the level of social deprivation. Methods All patients < 20 years who initiated KRT from 2010 to 2015 in metropolitan France were included. Data were collected from the comprehensive French registry of KRT French Renal Epidemiology and Information network (REIN). We used a validated ecological index to assess social deprivation, the 2011 French version of the European Deprivation Index (EDI). We estimated the age standardized incidence rates according to the quintiles of EDI using direct standardization and incidence rate ratio using Poisson regression. Results We included 672 children with kidney failure (58.6% males, 30.7% with glomerular or vascular disease, 43.3% starting KRT between 11 and 17 years). 38.8% were from the most deprived areas (quintile 5 of EDI). The age standardized incidence rate increased with quintile of EDI, from 5.45 (95% confidence interval [CI] = 4.25-6.64) per million children per year in the least deprived quintile to 8.46 (95% CI = 7.41-9.51) in the most deprived quintile of EDI (incidence rates ratio Q5 vs. Q1 1.53-fold; 95% CI = 1.18-2.01). Conclusion This study showed that even in a country with a universal health care system, there is a strong association between the incidence of pediatric KRT and social deprivation showing that social health inequalities appear from KRT initiation. This study highlights the need to look further into social inequalities in the earliest stage of chronic kidney disease (CKD).
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Affiliation(s)
- Bénédicte Driollet
- University of Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
- INSERM, Clinical Investigation Center-Clinical Epidemiology CIC-1401, Bordeaux, France
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Quebec, Canada
| | - Cécile Couchoud
- REIN registry, Agence de la Biomédecine, La Plaine-Saint Denis, France
| | - Justine Bacchetta
- Pediatric Nephrology Unit, Centre de Référence des Maladies Rénales Rares Nephrogones, Femme Mère Enfants Hospital, Hospices Civils de Lyon, Bron, France
| | - Olivia Boyer
- Pediatric Nephrology Unit, Centre de Référence des Maladies Rénales Rares MARHEA, Necker-Enfants Malades Hospital, Imagine Institute, Université Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Julien Hogan
- Pediatric Nephrology Unit, Centre de Référence des Maladies Rénales Rares Marhea, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Denis Morin
- Pediatric Nephrology Unit, Centre de Référence des Maladies Rénales Rares Sorare, Arnaud de Villeneuve Hospital, Montpellier University Hospital, Montpellier, France
| | - François Nobili
- Department of Pediatrics, Besançon University Hospital, Besançon, France
| | - Michel Tsimaratos
- REIN registry, Agence de la Biomédecine, La Plaine-Saint Denis, France
- Pediatric Nephrology Unit, La Timone University Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Etienne Bérard
- Department of Pediatrics, Nice University Hospital, Nice, France
| | - Florian Bayer
- REIN registry, Agence de la Biomédecine, La Plaine-Saint Denis, France
| | - Ludivine Launay
- INSERM-UCN U1086 Anticipe, Equipe Labellisée Ligue Contre le Cancer, Centre de Lutte contre le Cancer François Baclesse, Caen, France
| | - Karen Leffondré
- University of Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
- INSERM, Clinical Investigation Center-Clinical Epidemiology CIC-1401, Bordeaux, France
| | - Jérôme Harambat
- University of Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
- INSERM, Clinical Investigation Center-Clinical Epidemiology CIC-1401, Bordeaux, France
- Pediatric Nephrology Unit, Centre de Référence Maladies rénales rares Sorare, Pellegrin-Enfants Hospital, Bordeaux University Hospital, Bordeaux, France
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Wong G, Guha C, Mallitt KA, van Zwieten A, Khalid R, Francis A, Jaure A, Kim S, Teixeira-Pinto A, Aquino M, Bernier-Jean A, Johnson DW, Hahn D, Reidlinger D, Ryan EG, Mackie F, McCarthy H, Varghese J, Kiriwandeniya C, Howard K, Larkins N, Macauley L, Walker A, Howell M, Caldwell P, Woodleigh R, Jesudason S, Carter S, Kennedy S, Alexander S, McTaggart S, Craig JC, Hawley CM. The randomized controlled trial (NAVKIDS 2) of a patient navigator program created for children with chronic kidney disease. Kidney Int 2024:S0085-2538(24)00450-2. [PMID: 38959996 DOI: 10.1016/j.kint.2024.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/25/2024] [Accepted: 05/30/2024] [Indexed: 07/05/2024]
Abstract
Patient navigators enable adult patients to circumnavigate complex health systems, improving access to health care and outcomes. Here, we aimed to evaluate the effects of a patient navigation program in children with chronic kidney disease (CKD). In this multi-center, randomized controlled trial, we randomly assigned children (aged 0-16 years) with CKD stages 1-5 (including children on dialysis or with kidney transplants), from low socioeconomic status backgrounds, and/or residing in remote areas, to receive patient navigation at randomization (immediate) or at six months (waitlist). The primary outcome was self-rated health (SRH) of participating children at six months, using intention to treat analysis. Secondary outcomes included caregivers' SRH and satisfaction with health care, children's quality of life, hospitalizations, and missed school days. Repeated measures of the primary outcome from baseline to six months were analyzed using cumulative logit mixed effects models. Semi-structured interviews were thematically evaluated. Of 398 screened children, 162 were randomized (80 immediate and 82 waitlist); mean age (standard deviation) of 8.8 (4.8) years with 64.8% male. SRH was not significantly different between the immediate and wait-listed groups at six months. There were also no differences across all secondary outcomes between the two groups. Caregivers' perspectives were reflected in seven themes: easing mental strain, facilitating care coordination, strengthening capacity to provide care, reinforcing care collaborations, alleviating family tensions, inability to build rapport and unnecessary support. Thus, in children with CKD, self-rated health may not improve in response to a navigator program, but caregivers gained skills related to providing and accessing care.
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Affiliation(s)
- Germaine Wong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia.
| | - Chandana Guha
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Kylie-Ann Mallitt
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Anita van Zwieten
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Rabia Khalid
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia; Charles Perkins Centre, The University of Sydney, New South Wales, Australia
| | - Anna Francis
- Child and Adolescent Renal Services, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Allison Jaure
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Siah Kim
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Martha Aquino
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Amelie Bernier-Jean
- CIUSSS du Nord-de-l'Île de Montréal, University of Montréal, Montreal, Canada
| | - David W Johnson
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia; Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Australasian Kidney Trials Network, Translational Research Institute, Brisbane, Queensland, Australia
| | - Deirdre Hahn
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Donna Reidlinger
- Australasian Kidney Trials Network, Translational Research Institute, Brisbane, Queensland, Australia; Department of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth G Ryan
- QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Fiona Mackie
- Department of Nephrology, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia
| | - Hugh McCarthy
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Julie Varghese
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Charani Kiriwandeniya
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Kirsten Howard
- Menzies Centre for Health Policy, Sydney, New South Wales, Australia; Economics and Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Larkins
- Department of Nephrology, Perth Children's Hospital, Perth, Western Australia, Australia; School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | | | - Amanda Walker
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Menzies Centre for Health Policy, Sydney, New South Wales, Australia; Economics and Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Patrina Caldwell
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Reginald Woodleigh
- Prostate and Breast Cancer Foundation (CanCare), Sydney, New South Wales, Australia
| | - Shilpa Jesudason
- Central Northern Adelaide Renal and Transplantation Service (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Simon Carter
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Sean Kennedy
- School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia; Department of Nephrology, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia
| | - Stephen Alexander
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Steve McTaggart
- Child and Adolescent Renal Services, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia
| | - Carmel M Hawley
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia; Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Australasian Kidney Trials Network, Translational Research Institute, Brisbane, Queensland, Australia; Department of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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4
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van Zwieten A, Kim S, Dominello A, Guha C, Craig JC, Wong G. Socioeconomic Position and Health Among Children and Adolescents With CKD Across the Life-Course. Kidney Int Rep 2024; 9:1167-1182. [PMID: 38707834 PMCID: PMC11068961 DOI: 10.1016/j.ekir.2024.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/12/2023] [Accepted: 01/22/2024] [Indexed: 05/07/2024] Open
Abstract
Children and adolescents in families of lower socioeconomic position (SEP) experience an inequitable burden of reduced access to healthcare and poorer health. For children living with chronic kidney disease (CKD), disadvantaged SEP may exacerbate their considerable disease burden. Across the life-course, CKD may also compromise the SEP of families and young people, leading to accumulating health and socioeconomic disadvantage. This narrative review summarizes the current evidence on relationships of SEP with kidney care and health among children and adolescents with CKD from a life-course approach, including impacts of family SEP on kidney care and health, and bidirectional impacts of CKD on SEP. It highlights relevant conceptual models from social epidemiology, current evidence, clinical and policy implications, and provides directions for future research. Reflecting the balance of available evidence, we focus primarily on high-income countries (HICs), with an overview of key issues in low- and middle-income countries (LMICs). Overall, a growing body of evidence indicates sobering socioeconomic inequities in health and kidney care among children and adolescents with CKD, and adverse socioeconomic impacts of CKD. Dedicated efforts to tackle inequities are critical to ensuring that all young people with CKD have the opportunity to live long and flourishing lives. To prevent accumulating disadvantage, the global nephrology community must advocate for local government action on upstream social determinants of health; and adopt a life-course approach to kidney care that proactively identifies and addresses unmet social needs, targets intervening factors between SEP and health, and minimizes adverse socioeconomic outcomes across financial, educational and vocational domains.
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Affiliation(s)
- Anita van Zwieten
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Siah Kim
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Amanda Dominello
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Chandana Guha
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Jonathan C. Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Germaine Wong
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
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5
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Grossi AA, Potena L, Rossano JW, Breathett K. Socioeconomic deprivation and heart transplantation: A call for progress in the United States and EUROPE. J Heart Lung Transplant 2024; 43:334-336. [PMID: 37884164 DOI: 10.1016/j.healun.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Affiliation(s)
- Alessandra Agnese Grossi
- Department of Human Sciences, Innovation and Territory, University of Insubria, Varese-Como, Italy; Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
| | - Luciano Potena
- Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy.
| | - Joseph W Rossano
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Krannert Cardiovascular Center, Indiana University, Indianapolis, Indiana
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Kazes I, Solignac J, Lassalle M, Mercadal L, Couchoud C. Twenty years of the French Renal Epidemiology and Information Network. Clin Kidney J 2024; 17:sfad240. [PMID: 38186909 PMCID: PMC10768769 DOI: 10.1093/ckj/sfad240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Indexed: 01/09/2024] Open
Abstract
Background The French Renal Epidemiology and Information Network (REIN) is 20 years old. It is not just a national data registry, but rather an epidemiological and informational network serving patients with chronic kidney disease, nephrology teams and health services. Methods The past 10-year trends of the incidence and prevalence of renal replacement therapy by dialysis or kidney transplantation and waitlist activity are presented. To detect potential significant changes in trends from 2012 and 2021, a Joinpoint regression model was used. Results The overall incidence of treated end-stage kidney disease (ESKD) was 169 per million population (pmp) in 2021. It was stable despite an increase in the incidence of diabetes. We found a decreasing trend in the proportion of patients starting dialysis in an emergency but an increase in those starting haemodialysis (HD) with a temporary catheter. Peritoneal dialysis decreased by 1.7% each year, whereas home HD, although involving only 1% of dialysis patients, increased by 10% each year. For patients not treated at home, the median time to drive from the patient's home to the dialysis unit was 17 min. The proportion of patients on the transplantation waitlist at the start of dialysis increased from 7% to 12%. Among the 111 263 new ESKD patients from 2012 to 2021, 8% received a first transplant at 1 year and 20% at 5 years. Among kidney transplant recipients, the mean time on the waitlist increased from 13.8 to 22.6 months. Living donor transplants increased in frequency, representing 15% of kidney transplants. Conclusions Data from the REIN registry allow for the evaluation of needs and provide a planning tool for French authorities. The progressive implementation of automatic data retrieval from dialysis informatics charts might alleviate the burden of data collection. Furthermore, the research activity the REIN engenders, resulting in renewed confidence by health authorities in the dynamism of French nephrology, allows for an optimistic outlook for the REIN.
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Affiliation(s)
- Isabelle Kazes
- Service de Néphrologie, Centre Hospitalo-Universitaire de Reims, Reims, France
| | - Justine Solignac
- Service de Néphrologie, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Mathilde Lassalle
- Registre REIN, Agence de la biomédecine, Saint Denis La Plaine, France
| | - Lucile Mercadal
- Service de Néphrologie, Hôpital de la Pitié Salpêtrière, APHP, Paris, France
| | - Cécile Couchoud
- Registre REIN, Agence de la biomédecine, Saint Denis La Plaine, France
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Brugha R, Wu D, Spencer H, Marson L. Disparities in lung transplantation in children. Pediatr Pulmonol 2023. [PMID: 38131456 DOI: 10.1002/ppul.26813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 11/17/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023]
Abstract
Lung transplantation is a recognized therapy for end-stage respiratory failure in children and young people. It is only available in selected countries and is limited by access to suitable organs. Data on disparities in access and outcomes for children undergoing lung transplantation are limited. It is clear from data from studies in adults, and from studies in other solid organ transplants in children, that systemic inequities exist in this field. While data relating specifically to pediatric lung transplantation are relatively sparse, professionals should be aware of the risk that healthcare systems may result in disparities in access and outcomes following lung transplantation in children.
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Affiliation(s)
- Rossa Brugha
- Cardiothoracic Transplantation, Great Ormond Street Hospital, London, UK
- Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Diana Wu
- General Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Helen Spencer
- Cardiothoracic Transplantation, Great Ormond Street Hospital, London, UK
| | - Lorna Marson
- Transplant Unit, Royal Infirmary Edinburgh, Edinburgh, UK
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8
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McElroy LM, Schappe T, Mohottige D, Davis L, Peskoe SB, Wang V, Pendergast J, Boulware LE. Racial Equity in Living Donor Kidney Transplant Centers, 2008-2018. JAMA Netw Open 2023; 6:e2347826. [PMID: 38100105 PMCID: PMC10724764 DOI: 10.1001/jamanetworkopen.2023.47826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Abstract
Importance It is unclear whether center-level factors are associated with racial equity in living donor kidney transplant (LDKT). Objective To evaluate center-level factors and racial equity in LDKT during an 11-year time period. Design, Setting, and Participants A retrospective cohort longitudinal study was completed in February 2023, of US transplant centers with at least 12 annual LDKTs from January 1, 2008, to December 31, 2018, identified in the Health Resources Services Administration database and linked to the US Renal Data System and the Scientific Registry of Transplant Recipients. Main Outcomes and Measures Observed and model-based estimated Black-White mean LDKT rate ratios (RRs), where an RR of 1 indicates racial equity and values less than 1 indicate a lower rate of LDKT of Black patients compared with White patients. Estimated yearly best-case center-specific LDKT RRs between Black and White individuals, where modifiable center characteristics were set to values that would facilitate access to LDKT. Results The final cohorts of patients included 394 625 waitlisted adults, of whom 33.1% were Black and 66.9% were White, and 57 222 adult LDKT recipients, of whom 14.1% were Black and 85.9% were White. Among 89 transplant centers, estimated yearly center-level RRs between Black and White individuals accounting for center and population characteristics ranged from 0.0557 in 2008 to 0.771 in 2018. The yearly median RRs ranged from 0.216 in 2016 to 0.285 in 2010. Model-based estimations for the hypothetical best-case scenario resulted in little change in the minimum RR (from 0.0557 to 0.0549), but a greater positive shift in the maximum RR from 0.771 to 0.895. Relative to the observed 582 LDKT in Black patients and 3837 in White patients, the 2018 hypothetical model estimated an increase of 423 (a 72.7% increase) LDKTs for Black patients and of 1838 (a 47.9% increase) LDKTs for White patients. Conclusions and Relevance In this cohort study of patients with kidney failure, no substantial improvement occurred over time either in the observed or the covariate-adjusted estimated RRs. Under the best-case hypothetical estimations, modifying centers' participation in the paired exchange and voucher programs and increased access to public insurance may contribute to improved racial equity in LDKT. Additional work is needed to identify center-level and program-specific strategies to improve racial equity in access to LDKT.
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Affiliation(s)
- Lisa M. McElroy
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Tyler Schappe
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Dinushika Mohottige
- Institute of Health Equity Research and Barbara T. Murphy Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - LaShara Davis
- Department of Surgery and J. C. Walter Jr Transplant Center, Houston Methodist Hospital, Houston, Texas
| | - Sarah B. Peskoe
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Virginia Wang
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Jane Pendergast
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - L. Ebony Boulware
- Wake Forest University School of Medicine, Winston Salem, North Carolina
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9
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Chatelet V, Bayat S, Driollet B, Merle V, Moranne O, Lassalle M. [REIN: a tool to highlight inequalities in health]. Nephrol Ther 2023; 18:50-53. [PMID: 37638509 DOI: 10.1016/s1769-7255(22)00568-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
On the occasion of the 20th anniversary of the REIN (French Renal Epidemiology and Information Network), a summary work on the contributions of the national French ESKD register was carried out. On the issue of Social Inequalities in Health, the following key messages were retained. Social inequalities in health exist throughout the journey of a patient with chronic kidney disease and manifest as territorial inequalities in access to home-based or independent dialysis treatment and to transplant, whether preemptive or otherwise. SIH are observed in adults as well as in the paediatric population. The female gender appears to be associated with a disparity in access to kidney transplant.
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Affiliation(s)
| | - Sahar Bayat
- Coordination régionale Bretagne, EHESP, Rennes, France
| | - Bénédicte Driollet
- INSERM U1219 – Bordeaux Population Health Research Center, Bordeaux University, ISPED, France
| | | | - Olivier Moranne
- Coordination régionale Languedoc-Roussillon, Hôpital universitaire de Nîmes, Carémeau, Nîmes, France
- UMR INSERM-UM, Institut Desbrest d’épidémiologie et santé publique (IDESP), Campus Santé, Montpellier, France
| | - Mathilde Lassalle
- Coordination nationale REIN, Agence de la biomédecine, Saint-Denis-La Plaine, France
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10
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Bérard É, Harambat J, Hogan J, Parmentier C, Béchade C, Lassalle M. [REIN: a tool at the service of the paediatric patients]. Nephrol Ther 2023; 18:59-64. [PMID: 37638511 DOI: 10.1016/s1769-7255(22)00570-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
On the occasion of the 20th anniversary of the REIN (French Renal Epidemiology and Information Network), a summary work on the contributions of the national French ESKD register was carried out. On the issue of paediatric CKD patients, the following key messages were retained. Paediatric stage 5 chronic kidney disease (CKD) has particularities that require to be analysed and taken into account because the mortality of these patients remains 30 times higher than that of children of the same age. The REIN registry enables illustrating the specificities of stage 5 CKD in the paediatric age-group in France and providing a set of indicators making it possible to describe the future of these patients as well as the choices made concerning the modalities of replacement therapy. As compared to other European countries, the incidence and prevalence of stage 5 CKD in France is in the middle range for children under 15 and 20 years old. Renal transplant is by far the leading treatment for stage 5 CKD in children and adolescents under 18 years of age in France, allowing to offer these patients the best possible life expectancy. Owing to the small volume of patients, only a nationwide registry can provide an unbiased view and enables analysing this population requiring a hyperspecialised treatment. The participation of French paediatric nephrologists in the REIN French registry also enables providing input to the European registry (ESPN/ERA www.espn-reg.org/index.jsp) and the international registry (IPNA https://ipna-registry.org) (Consulted on September 15th 2022) and thus the possibility of international studies, which are vital to be in line with an approach to improving practices.
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Affiliation(s)
| | - Jérôme Harambat
- Unité de néphrologie, Service de pédiatrie, CHU de Bordeaux, Hôpital Pellegrin-Enfants, Bordeaux, France
| | - Julien Hogan
- Service de néphrologie – Hémodialyse, Pôle de pédiatrie médicale, AP-HP, Hôpital Robert-Debré, Paris, France
| | - Cyrielle Parmentier
- Service de néphrologie – Hémodialyse, AP-HP, Hôpital Armand-Trousseau, Paris, France
| | | | - Mathilde Lassalle
- Coordination nationale REIN, Agence de la biomédecine, Saint-Denis-La Plaine, France
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11
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Francis-Oliviero F, Driollet B, Alla F. Pediatric health professionals' perceptions of social health inequalities and proportionate universalism in a French academic hospital: a qualitative study. Eur J Pediatr 2023:10.1007/s00431-023-05005-0. [PMID: 37171520 PMCID: PMC10176283 DOI: 10.1007/s00431-023-05005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/13/2023]
Abstract
To describe healthcare professionals' perceptions of social health inequalities in the context of pediatric chronic disease and their insights regarding proportionate universalism as a potential solution to reduce them. Semi-directive interviews were conducted with healthcare professionals from different pediatric chronic disease departments of a single French academic hospital. This qualitative study was based on an inductive thematic analysis; an interview topic guide was used for the interviews and the analysis. In this study, we highlighted three main themes: the healthcare professionals' perceptions of social health inequalities in their practices, their beliefs regarding the causality of those inequalities, and potential solutions proposed by healthcare professionals to reduce them. Healthcare professionals very often associated inequalities with socio-economic precariousness or geographical disparities but were not familiar with the notion of a social gradient. Paradoxically, while they claimed not to differentiate among patients in their practice, they did report adapting care, depending on the social situation. For healthcare professionals, inequalities were the result of misunderstood problems, a lack of family support, a failure of the prevention system, and a lack of financial resources. CONCLUSION We still need to develop solutions to tackle those inequalities at every level of the healthcare system, and healthcare professionals must be more actively involved in this effort. One approach is to adapt public health principles such as proportionate universalism to individual care. WHAT IS KNOWN • Social health inequalities exist in pediatric care and a social gradient has been shown in many clinical situations. • Exploring health professionals' perceptions of social health inequalities can lead to solutions to tackle them. WHAT IS NEW • Pediatricians and pediatric nurses were not fully aware of the social gradient of health. • Although they claimed not to differentiate between patients in their practice, healthcare professionals did adapt care when complicated social situations arose.
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Affiliation(s)
- Florence Francis-Oliviero
- Centre INSERM U1219, University of Bordeaux, ISPED, Bordeaux Population Health, Bordeaux, France.
- Pôle de Santé Publique, Service d'Information Médicale, CHU de Bordeaux, Bordeaux, France.
| | - Bénédicte Driollet
- Centre INSERM U1219, University of Bordeaux, ISPED, Bordeaux Population Health, Bordeaux, France
| | - François Alla
- Centre INSERM U1219, University of Bordeaux, ISPED, Bordeaux Population Health, Bordeaux, France
- Pôle de Santé Publique, Service de Soutien Méthodologique et d'Innovation en Prévention, CHU de Bordeaux, Bordeaux, France
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12
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Bañuelos Marco B, Donmez I, Geppert T, Prudhomme T, Campi R, Mesnard B, Hevia V, Boissier R, Pecoraro A, Territo A. Renal transplantation in pediatric recipients: Considerations and preoperative assessment strategies. Actas Urol Esp 2023:S2173-5786(23)00038-0. [PMID: 36965856 DOI: 10.1016/j.acuroe.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 03/27/2023]
Abstract
INTRODUCTION AND OBJECTIVE Renal transplantation in the pediatric population differs from adults in many aspects. This review will focus on the unique issues of the pediatric recipient. MATERIAL AND METHODS A narrative review on the scarce literature regarding preoperative evaluation before kidney transplantation of the paediatric recipient with an educational focus was conducted. The literature search allowed for identification of publications in English from January 2000 to October 2022. Published studies were identified by searching the following electronic databases: PubMed (MEDLINE), WHO/UNAIDS, Google-Scholar, Semantic-Scholar and Research Gate. For efficiency and reliability, recent randomized controlled trials, meta-analyses, high quality systematic reviews and large well-designed studies were used if available. Internet searches were conducted for other relevant information (definitions, policies or guidelines). RESULTS Management of congenital urogenital anomalies and lower urinary tract dysfunction along with optimal pediatric urological preoperative assessment for renal transplantation in children is addressed in the light of the available literature. Furthermore, particular considerations including pre-emptive transplantation, transplantation of an adult-size kidney into an infant or small child is discussed. CONCLUSIONS Outcomes of RT in children have shown progressive improvement over the past 15 years. Transplantation with living related donor gives the best results and pre-emptive transplantation provides with benefits of avoiding dialysis. Surgical and medical considerations in both the pre-transplant and post-transplant management of the pediatric kidney recipient are extremely crucial in order to achieve better short and long-term results.
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Affiliation(s)
- B Bañuelos Marco
- Department of Urology, Renal Transplant Unit Hospital Universitario Clínico San Carlos, Madrid, Spain.
| | - I Donmez
- Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Estambul, Turkey
| | - T Geppert
- Division of Pediatric Urology, Department of Urology, University Hospital Charité Berlin, Berlin, Germany
| | - T Prudhomme
- Department of Urology and Kidney Transplantation, Toulouse University Hospital, Toulouse, France
| | - R Campi
- Department of Urology, Florence University Hospital, Florence, Italy
| | - B Mesnard
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
| | - V Hevia
- Urology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - R Boissier
- Department of Urology, La Conception University Hospital, Marseille, France
| | - A Pecoraro
- Department of Urology, Florence University Hospital, Florence, Italy
| | - A Territo
- Oncology and Renal Transplant Units, Puigvert's Foundation, Barcelona, Spain
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13
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Harambat J, Morin D. [Epidemiology of childhood chronic kidney diseases]. Med Sci (Paris) 2023; 39:209-218. [PMID: 36943117 DOI: 10.1051/medsci/2023027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Major advances have been made in the management of children with chronic kidney disease (CKD) over the past 30 years. However, existing epidemiological data mainly relies on registries of chronic kidney replacement therapy. The incidence and prevalence of earlier stages of CKD remain largely unknown, but rare population-based studies suggest that the prevalence of all stages CKD may be as high as 1 % of the pediatric population. Congenital disorders including renal hypodysplasia and uropathy (CAKUT) and hereditary nephropathies account for one-half to two-thirds of childhood CKD cases in high-income countries, whereas acquired nephropathies predominate in developing countries. CKD progression is slower in children with congenital disorders than in those with glomerular nephropathy, and other risk factors for progression have also been identified. Children with CKD have poorer health-related quality of life when compared to healthy children. While survival of children with CKD has continuously improved over time, mortality remains 20 to 30 times higher than in the general pediatric population.
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Affiliation(s)
- Jérôme Harambat
- Département de pédiatrie, Centre de référence maladies rénales rares du Sud-Ouest (SORARE), filière de santé ORKiD, CHU de Bordeaux, Bordeaux, France
| | - Denis Morin
- Département de pédiatrie, Centre de référence maladies rénales rares du Sud-Ouest (SORARE), filière de santé ORKiD, CHU de Montpellier, Montpellier, France
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14
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Abstract
Peritoneal dialysis (PD) is an important home-based treatment for kidney failure and accounts for 11% of all dialysis and 9% of all kidney replacement therapy globally. Although PD is available in 81% of countries, this provision ranges from 96% in high-income countries to 32% in low-income countries. Compared with haemodialysis, PD has numerous potential advantages, including a simpler technique, greater feasibility of use in remote communities, generally lower cost, lesser need for trained staff, fewer management challenges during natural disasters, possibly better survival in the first few years, greater ability to travel, fewer dietary restrictions, better preservation of residual kidney function, greater treatment satisfaction, better quality of life, better outcomes following subsequent kidney transplantation, delayed need for vascular access (especially in small children), reduced need for erythropoiesis-stimulating agents, and lower risk of blood-borne virus infections and of SARS-CoV-2 infection. PD outcomes have been improving over time but with great variability, driven by individual and system-level inequities and by centre effects; this variation is exacerbated by a lack of standardized outcome definitions. Potential strategies for outcome improvement include enhanced standardization, monitoring and reporting of PD outcomes, and the implementation of continuous quality improvement programmes and of PD-specific interventions, such as incremental PD, the use of biocompatible PD solutions and remote PD monitoring. The use of peritoneal dialysis (PD) can be advantageous compared with haemodialysis treatment, although several barriers limit its broad implementation. This review examines the epidemiology of peritoneal dialysis (PD) outcomes, including clinical, patient-reported and surrogate PD outcomes. Peritoneal dialysis (PD) has distinct advantages compared with haemodialysis, including the convenience of home treatment, improved quality of life, technical simplicity, lesser need for trained staff, greater cost-effectiveness in most countries, improved equity of access to dialysis in resource-limited settings, and improved survival, particularly in the first few years of initiating therapy. Important barriers can hamper PD utilization in low-income settings, including the high costs of PD fluids (owing to the inability to manufacture them locally and the exorbitant costs of their import), limited workforce availability and a practice culture that limits optimal PD use, often leading to suboptimal outcomes. PD outcomes are highly variable around the world owing in part to the use of variable outcome definitions, a heterogeneous practice culture, the lack of standardized monitoring and reporting of quality indicators, and kidney failure care gaps (including health care workforce shortages, inadequate health care financing, suboptimal governance and a lack of good health care information systems). Key outcomes include not only clinical outcomes (typically defined as medical outcomes based on clinician assessment or diagnosis) — for example, PD-related infections, technique survival, mechanical complications, hospitalizations and PD-related mortality — but also patient-reported outcomes. These outcomes are directly reported by patients and focus on how they function or feel, typically in relation to quality of life or symptoms; patient-reported outcomes are used less frequently than clinical outcomes in day-to-day routine care.
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15
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van Zwieten A, Wong G, Qader MA. Tackling health inequities for children and adolescents with chronic kidney disease – a call to advocacy and action across the life-course. Kidney Int Rep 2022; 7:671-674. [PMID: 35497808 PMCID: PMC9039902 DOI: 10.1016/j.ekir.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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