Social Deprivation Is Associated With Lower Access to Pre-emptive Kidney Transplantation and More Urgent-Start Dialysis in the Pediatric Population

Bénédicte Driollet (1) , Florian Bayer (2) , Theresa Kwon (3) , Saoussen Krid (4) , Bruno Ranchin (5) , Michel Tsimaratos (6) , Cyrielle Parmentier (7) , Robert Novo (8) , Gwenaelle Roussey (9) , Stéphanie Tellier (10) , Marc Fila (11) , Ariane Zaloszyc (12) , Astrid Godron-Dubrasquet (13) , Sylvie Cloarec (14) , Isabelle Vrillon (15) , Françoise Broux (16) , Etienne Bérard (17) , Sophie Taque (18) , Christine Pietrement (19) , François Nobili (20) , Vincent Guigonis (21) , Ludivine Launay (22) , Cécile Couchoud (2) , Jérôme Harambat (23, 24, 25, 1) , Karen Leffondré (25, 1)

1 BPH - Bordeaux population health
2 Agence de la biomédecine [Saint-Denis la Plaine]
3 Hôpital Robert Debré
4 Hôpital Necker - Enfants Malades [AP-HP]
5 HCL - Hospices Civils de Lyon
6 TIMONE - Hôpital de la Timone [CHU - APHM]
7 CHU Trousseau [APHP]
8 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
9 CHU Nantes - Centre Hospitalier Universitaire de Nantes
10 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
11 CHU Montpellier
12 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
13 Hôpital Pellegrin
14 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
15 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
16 CHU Rouen
17 CHU Nice - Centre Hospitalier Universitaire de Nice
18 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
19 Hôpital universitaire Robert Debré [Reims]
20 Service de pédiatrie [CHRU Besançon]
21 CHU Limoges
22 ANTICIPE - Unité de recherche interdisciplinaire pour la prévention et le traitement des cancers
23 Centre de Référence du Sud Ouest des Maladies Rénales Rares
24 CHU Bordeaux
25 CIC Bordeaux

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.

Mots clés: dialysis initiation; end stage kidney disease; French EDI; pediatric kidney replacement therapy; social deprivation

Domaines: Médecine humaine et pathologie

Bénédicte Driollet, Florian Bayer, Theresa Kwon, Saoussen Krid, Bruno Ranchin, et al.. Social Deprivation Is Associated With Lower Access to Pre-emptive Kidney Transplantation and More Urgent-Start Dialysis in the Pediatric Population. Kidney International Reports, 2021, 11p. ⟨10.1016/j.ekir.2021.12.015⟩. ⟨hal-03563361⟩