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Driollet B, Bayer F, Kwon T, Krid S, Ranchin B, Tsimaratos M, Parmentier C, Novo R, Roussey G, Tellier S, Fila M, Zaloszyc A, Godron-Dubrasquet A, Cloarec S, Vrillon I, Broux F, Bérard E, Taque S, Pietrement C, Nobili F, Guigonis V, Launay L, Couchoud C, Harambat J, Leffondré K. Social Deprivation Is Associated With Lower Access to Pre-emptive Kidney Transplantation and More Urgent-Start Dialysis in the Pediatric Population. Kidney Int Rep 2022; 7:741-751. [PMID: 35497781 PMCID: PMC9039898 DOI: 10.1016/j.ekir.2021.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/06/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Socioeconomic status (SES) is recognized as an important determinant of kidney health. We aimed to evaluate the association of social deprivation with different indicators at kidney replacement therapy (KRT) initiation in the French pediatric metropolitan population. Methods All patients with end-stage kidney disease (ESKD) who started KRT before 20 years old in France between 2002 and 2015 were included. We investigated different indicators at KRT initiation, which are as follows: KRT modality (dialysis vs. pre-emptive transplantation), late referral to a nephrologist, and dialysis modality (hemodialysis [HD] vs. peritoneal dialysis [PD], urgent vs. planned start of dialysis, use of catheter vs. use of fistula for HD vascular access). An ecological index (European Deprivation Index [EDI]) was used as a proxy for social deprivation. Results A total of 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 pediatric patients with ESKD come from a more socially deprived background. The most deprived group was more likely to initiate KRT with dialysis versus kidney transplantation. Among patients on HD, the odds of starting treatment in emergency with a catheter was >2-fold higher for the most deprived compared with the least deprived children (adjusted odds ratio [aOR] 2.35, 95% CI 1.16-4.78). Conclusion Children from the most deprived area have lower access to pre-emptive transplantation, have lower access to PD, tend to be late referred to a nephrologist, and have more urgent initiation of HD with a catheter.
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Affiliation(s)
- Bénédicte Driollet
- Univ Bordeaux, Institut National de la Santé et de la Recherche Médicale, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
| | - Florian Bayer
- Agence de la Biomédecine, Renal Epidemiology and Information Network Registry, La Plaine-Saint Denis, France
| | - Theresa Kwon
- Pediatric Nephrology Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Saoussen Krid
- Pediatric Nephrology Unit, Centre de Référence des Maladies Rénales Rares, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bruno Ranchin
- Pediatric Nephrology Unit, Centre de Référence des Maladies Rénales Rares, Femme Mère Enfants University Hospital, Hospices Civils de Lyon, Bron, France
| | - Michel Tsimaratos
- Pediatric Nephrology Unit, La Timone University Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Cyrielle Parmentier
- Pediatric Nephrology Unit, Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Robert Novo
- Pediatric Nephrology Unit, Lille University Hospital, Lille, France
| | - Gwenaelle Roussey
- Pediatric Nephrology Unit, Nantes University Hospital, Nantes, France
| | - Stéphanie Tellier
- Pediatric Nephrology Unit, Centre de Référence des Maladies Rénales Rares, Toulouse University Hospital, Toulouse, France
| | - Marc Fila
- Pediatric Nephrology Unit, Montpellier University Hospital, Montpellier, France
| | - Ariane Zaloszyc
- Pediatric Nephrology Unit, Strasbourg University Hospital, Strasbourg, France
| | - Astrid Godron-Dubrasquet
- Pediatric Nephrology Unit, Centre de Référence des Maladies Rénales Rares Sorare, Pellegrin-Enfants Hospital, Bordeaux University Hospital, Bordeaux, France
| | - Sylvie Cloarec
- Pediatric Nephrology Unit, Tours University Hospital, Tours, France
| | - Isabelle Vrillon
- Pediatric Nephrology Unit, Nancy University Hospital, Nancy, France
| | - Françoise Broux
- Department of Pediatrics, Rouen University Hospital, Rouen, France
| | - Etienne Bérard
- Department of Pediatrics, Nice University Hospital, Nice, France
| | - Sophie Taque
- Department of Pediatrics, Rennes University Hospital, Rennes, France
| | | | - François Nobili
- Department of Pediatrics, Besançon University Hospital, Besançon, France
| | - Vincent Guigonis
- Department of Pediatrics, Limoges University Hospital, Limoges, France
| | - Ludivine Launay
- Institut National de la Santé et de la Recherche Médicale-UCN U1086 Anticipe, Centre de Lutte contre le Cancer François Baclesse, Caen, France
| | - Cécile Couchoud
- Agence de la Biomédecine, Renal Epidemiology and Information Network Registry, La Plaine-Saint Denis, France
| | - Jérôme Harambat
- Univ Bordeaux, Institut National de la Santé et de la Recherche Médicale, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
- Pediatric Nephrology Unit, Centre de Référence des Maladies Rénales Rares Sorare, Pellegrin-Enfants Hospital, Bordeaux University Hospital, Bordeaux, France
- Univ Bordeaux, Institut National de la Santé et de la Recherche Médicale, CIC-1401-EC, Bordeaux, France
| | - Karen Leffondré
- Univ Bordeaux, Institut National de la Santé et de la Recherche Médicale, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
- Univ Bordeaux, Institut National de la Santé et de la Recherche Médicale, CIC-1401-EC, Bordeaux, France
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