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Al-Chalabi S, Parkinson E, Chinnadurai R, Kalra PA, Sinha S. Association of deprivation and its individual domains on outcomes in people with chronic kidney disease. Clin Kidney J 2024; 17:sfae086. [PMID: 39015838 PMCID: PMC11249924 DOI: 10.1093/ckj/sfae086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Indexed: 07/18/2024] Open
Abstract
Background Due to the high correlation of chronic kidney disease (CKD) with other comorbidities, the sole effect of CKD on deprived people is not clear. In addition, there is a paucity of evidence in the literature linking isolated domains of deprivation to outcomes. This study aimed to examine whether deprivation was associated with adverse outcomes in patients with CKD, independent of cardiometabolic morbidities. Individual domains of deprivation were also evaluated. Methods A retrospective study of patients with non-dialysis-dependent CKD (ND-CKD) in the Salford Kidney Study to investigate the association of deprivation with outcomes. The English Indices of Deprivation was used for the comparative analysis of the five quintiles of deprivation. Two propensity score methods were used to attenuate the confounding effect of cardiometabolic morbidities between the least and the most deprived groups. Results People living in the least deprived areas (n = 319) had a lower risk of combined outcomes (all-cause mortality and renal replacement therapy) when compared with the most deprived group (n = 813) [hazard ratio (HR) 0.83; 95% confidence interval (CI) 0.71-0.98]. The negative association of deprivation remained after matching but with mixed statistical significance when using different propensity methods (HR 0.85; 95% CI 0.70-1.03 for propensity score matching and HR 0.77; 95% CI 0.61-0.98 for inverse probability weighting). The association of combined outcomes varied across component index of multiple deprivation domains with wide CIs. However, areas with lower scores for education, income and employment were significantly associated with a higher risk. Conclusions This study has identified that in people with ND-CKD, unemployment, poor educational attainment and lower household income were associated with poor outcomes. The association of deprivation with adverse outcomes persists despite adjustment for cardiometabolic morbidities.
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Affiliation(s)
- Saif Al-Chalabi
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Eleanor Parkinson
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rajkumar Chinnadurai
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Philip A Kalra
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
| | - Smeeta Sinha
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
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Siligato R, Gembillo G, Di Simone E, Di Maria A, Nicoletti S, Scichilone LM, Capone M, Vinci FM, Bondanelli M, Malaventura C, Storari A, Santoro D, Di Muzio M, Dionisi S, Fabbian F. Financial Toxicity in Renal Patients (FINTORE) Study: A Cross-Sectional Italian Study on Financial Burden in Kidney Disease-A Project Protocol. Methods Protoc 2024; 7:34. [PMID: 38668141 PMCID: PMC11053909 DOI: 10.3390/mps7020034] [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: 02/21/2024] [Revised: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 04/29/2024] Open
Abstract
Financial toxicity (FT) refers to the negative impact of health-care costs on clinical conditions. In general, social determinants of health, especially poverty, socioenvironmental stressors, and psychological factors, are increasingly recognized as important determinants of non-communicable diseases, such as chronic kidney disease (CKD), and their consequences. We aim to investigate the prevalence of FT in patients at different stages of CKD treated in our universal health-care system and from pediatric nephrology, hemodialysis, peritoneal dialysis and renal transplantation clinics. FT will be assessed with the Patient-Reported Outcome for Fighting Financial Toxicity (PROFFIT) score, which was first developed by Italian oncologists. Our local ethics committee has approved the study. Our population sample will answer the sixteen questions of the PROFFIT questionnaire, seven of which are related to the outcome and nine the determinants of FT. Data will be analyzed in the pediatric and adult populations and by group stratification. We are confident that this study will raise awareness among health-care professionals of the high risk of adverse health outcomes in patients who have both kidney disease and high levels of FT. Strategies to reduce FT should be implemented to improve the standard of care for people with kidney disease and lead to truly patient-centered care.
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Affiliation(s)
- Rossella Siligato
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, 98121 Messina, Italy;
| | - Guido Gembillo
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, 98121 Messina, Italy;
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98121 Messina, Italy;
| | - Emanuele Di Simone
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (E.D.S.); (M.D.M.)
| | - Alessio Di Maria
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
| | - Simone Nicoletti
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
| | - Laura Maria Scichilone
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
| | - Matteo Capone
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.M.)
| | - Francesca Maria Vinci
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.M.)
| | - Marta Bondanelli
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.M.)
| | - Cristina Malaventura
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.M.)
| | - Alda Storari
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.M.)
| | - Domenico Santoro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98121 Messina, Italy;
| | - Marco Di Muzio
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (E.D.S.); (M.D.M.)
| | - Sara Dionisi
- Nursing, Technical and Rehabilitation, Department DATeR Azienda Unità Sanitaria Locale di Bologna, 40121 Bologna, Italy;
| | - Fabio Fabbian
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.M.)
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Fadini GP, Longato E, Morieri ML, Del Prato S, Avogaro A, Solini A. Long-term benefits of dapagliflozin on renal outcomes of type 2 diabetes under routine care: a comparative effectiveness study on propensity score matched cohorts at low renal risk. THE LANCET REGIONAL HEALTH. EUROPE 2024; 38:100847. [PMID: 38328413 PMCID: PMC10847023 DOI: 10.1016/j.lanepe.2024.100847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/29/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024]
Abstract
Background Despite the overall improvement in care, people with type 2 diabetes (T2D) experience an excess risk of end-stage kidney disease. We evaluated the long-term effectiveness of dapagliflozin on kidney function and albuminuria in patients with T2D. Methods We included patients with T2D who initiated dapagliflozin or comparators from 2015 to 2020. Propensity score matching (PSM) was performed to balance the two groups. The primary endpoint was the change in estimated glomerular filtration rate (eGFR) from baseline to the end of observation. Secondary endpoints included changes in albuminuria and loss of kidney function. Findings We analysed two matched groups of 6197 patients each. The comparator group included DPP-4 inhibitors (40%), GLP-1RA (22.3%), sulphonylureas (16.1%), pioglitazone (8%), metformin (5.8%), or acarbose (4%). Only 6.4% had baseline eGFR <60 ml/min/1.73 m2 and 15% had UACR >30 mg/g. During a mean follow-up of 2.5 year, eGFR declined significantly less in the dapagliflozin vs comparator group by 1.81 ml/min/1.73 m2 (95% C.I. from 1.13 to 2.48; p < 0.0001). The mean eGFR slope was significantly less negative in the dapagliflozin group by 0.67 ml/min/1.73 m2/year (95% C.I. from 0.47 to 0.88; p < 0.0001). Albuminuria declined significantly in new-users of dapagliflozin within 6 months and remained on average 44.3 mg/g lower (95% C.I. from -66.9 to -21.7; p < 0.0001) than in new-users of comparators. New-users of dapagliflozin had significantly lower rates of new-onset CKD, loss of kidney function, and a composite renal outcome. Results were confirmed for all SGLT2 inhibitors, in patients without baseline CKD, and when GLP-1RA were excluded from comparators. Interpretation Initiating dapagliflozin improved kidney function outcomes and albuminuria in patients with T2D and a low renal risk. Funding Funded by the Italian Diabetes Society and partly supported by a grant from AstraZeneca.
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Affiliation(s)
- Gian Paolo Fadini
- Division of Metabolic Diseases, Department of Medicine, University of Padova, 35128 Padova, Italy
- Laboratory of Experimental Diabetology, Veneto Institute of Molecular Medicine, 35128 Padova, Italy
| | - Enrico Longato
- Department of Information Engineering, University of Padova, 35100 Padua, Italy
| | - Mario Luca Morieri
- Division of Metabolic Diseases, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Stefano Del Prato
- Department of Clinical & Experimental Medicine, University of Pisa and Sant’Anna School of Advanced Studies, 56126 Pisa, Italy
| | - Angelo Avogaro
- Division of Metabolic Diseases, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Anna Solini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy
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Hedberg P, Sotoodeh A, Askling HH, Nauclér P. Sociodemographic disparities affect COVID-19 vaccine uptake in non-elderly adults with increased risk of severe COVID-19. J Intern Med 2023; 294:640-652. [PMID: 37424218 DOI: 10.1111/joim.13700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
BACKGROUND There is limited information about sociodemographic disparities in COVID-19 vaccine uptake among non-elderly adults with an increased risk of severe COVID-19. We investigated the COVID-19 vaccine uptake in individuals aged 18-64 years with an increased risk of severe COVID-19 (non-elderly risk group) in Stockholm County, Sweden. METHOD We used population-based health and sociodemographic registries with high coverage to perform a cohort study of COVID-19 vaccine uptake of one to four doses up until 21 November 2022. The vaccine uptake in the non-elderly risk group was compared with non-risk groups aged 18-64 years (non-elderly non-risk group) and individuals aged ≥65 years (elderly). RESULTS The uptake of ≥3 vaccine doses was 55%, 64% and 87% in the non-elderly non-risk group (n = 1,005,182), non-elderly risk group (n = 308,904) and elderly (n = 422,604), respectively. Among non-elderly risk group conditions, Down syndrome showed the strongest positive association with receiving three doses (adjusted risk ratio [aRR] 1.62, 95% confidence interval [CI] 1.54-1.71), whereas chronic liver disease showed the strongest negative association (aRR 0.90, 95% CI 0.88-0.92). Higher vaccine uptake among the non-elderly risk group was associated with increasing age, being born in Sweden, higher education, higher income and living in a household where other adults had been vaccinated. Similar trends were observed for the first, second, third and fourth doses. CONCLUSION These results call for measures to tackle sociodemographic disparities in vaccination programmes during and beyond the COVID-19 pandemic.
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Affiliation(s)
- Pontus Hedberg
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Adonis Sotoodeh
- Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Helena H Askling
- Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Academic Specialist Centre, Stockholm Health Care Services, Stockholm, Sweden
| | - Pontus Nauclér
- Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
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