Social deprivation could act as a barrier to peritoneal dialysis (PD). The objective of this study was to assess the association between social deprivation estimated by the European deprivation index (EDI) and PD uptake and to explore the potential mediators of this association.
Methods:
From the Renal Epidemiology and Information Network registry, patients who started dialysis in 2017 were included. The EDI was calculated based on the patient’s address. The event of interest was the proportion of PD 3 months after dialysis initiation. A mediation analysis with a counterfactual approach was carried out to evaluate the direct and indirect effect of the EDI on the proportion of PD.
Results:
Among the 9588 patients included, 1116 patients were on PD; 2894 (30.2%) patients belonged to the most deprived quintile (Q5). PD was associated with age >70 years (odds ratio (OR) 0.79 [95% confidence interval (CI): 0.69–0.91]), male gender (0.85 [95% CI: 0.74–0.97]), cardiovascular disease (OR 0.86 [95% CI: 0.86–1.00]), chronic heart failure (OR 1.34 [95% CI: 1.13–1.58]), active cancer (OR 0.67 [95% CI: 0.53–0.85]) and obesity (OR 0.75 [95% CI: 0.63–0.89]). In the mediation analysis, Q5 had a direct effect on PD proportion OR 0.84 [95% CI: 0.73–0.96]. The effect of Q5 on the proportion of PD was mediated by haemoglobin level at dialysis initiation (OR 0.96 [95% CI: 0.94–0.98]) and emergency start (OR 0.98 [95% CI: 0.96–0.99]).
Conclusion:
Social deprivation, estimated by the EDI, was associated with a lower PD uptake. The effect of social deprivation was mediated by haemoglobin level, a proxy of predialysis care and emergency start.
ChoYBelloAKLevinA, et al.Peritoneal dialysis use and practice patterns: an international survey study. Am J Kidney Dis2020; 77(3): 315–325.
2.
IyasereOUBrownEAJohanssonL, et al.Quality of life and physical function in older patients on dialysis: a comparison of assisted peritoneal dialysis with hemodialysis. Clin J Am Soc Nephrol2016; 11(3): 423–430.
3.
Loos-AyavCFrimatLKesslerM, et al.Changes in health-related quality of life in patients of self-care vs. in-center dialysis during the first year. Qual Life Res2008; 17(1): 1–9.
4.
KlarenbachSWTonelliMChuiB, et al.Economic evaluation of dialysis therapies. Nat Rev Nephrol2014; 10(11): 644–652.
5.
KaropadiANMasonGRettoreE, et al.Cost of peritoneal dialysis and haemodialysis across the world. Nephrol Dial Transplant2013; 28(10): 2553–2569.
6.
JustPMde CharroFThTschosikEA, et al.Reimbursement and economic factors influencing dialysis modality choice around the world. Nephrol Dial Transplant2008; 23(7): 2365–2373.
7.
BriggsVDaviesSWilkieM. International variations in peritoneal dialysis utilization and implications for practice. Am J Kidney Dis2019; 74(1): 101–110.
8.
CouchoudCSavoyeEFrimatL, et al.Variability in case mix and peritoneal dialysis selection in fifty-nine French districts. Perit Dial Int J2008; 28(5): 509–517.
9.
LiPKTChowKMVan de LuijtgaardenMWM, et al.Changes in the worldwide epidemiology of peritoneal dialysis. Nat Rev Nephrol2017; 13(2): 90–103.
10.
EthierIChoYHawleyC, et al.Effect of patient- and center-level characteristics on uptake of home dialysis in Australia and New Zealand: a multicenter registry analysis. Nephrol Dial Transplant2020; 35(11): 1938–1949.
11.
ChanCTWallaceEGolperTA, et al.Exploring barriers and potential solutions in home dialysis: An NKF-KDOQI conference outcomes report. Am J Kidney Dis2019; 73(3): 363–371.
12.
CastledineCIGilgJARogersC, et al.Renal centre characteristics and physician practice patterns associated with home dialysis use. Nephrol Dial Transplant2013; 28(8): 2169–2180.
13.
MannsBJTaubKVanderStraetenC, et al.The impact of education on chronic kidney disease patients’ plans to initiate dialysis with self-care dialysis: a randomized trial. Kidney Int2005; 68(4): 1777–1783.
14.
DevoeDJWongBJamesMT, et al.Patient education and peritoneal dialysis modality selection: a systematic review and meta-analysis. Am J Kidney Dis2016; 68(3): 422–433.
15.
MannsBAgarJWMBiyaniM, et al.Can economic incentives increase the use of home dialysis?Nephrol Dial Transplant2019; 34(5): 731–741.
16.
GraceBSClaytonPAGrayNA, et al.Socioeconomic differences in the uptake of home dialysis. Clin J Am Soc Nephrol2014; 9(5): 929–935.
17.
TrinhENaYSoodMM, et al.Racial differences in home dialysis utilization and outcomes in Canada. Clin J Am Soc Nephrol2017; 12(11): 1841–1851.
18.
JayantiAFodenPRaeA, et al.The influence of renal centre and patient sociodemographic factors on home haemodialysis prevalence in the UK. Nephron2017; 136(2): 62–74.
19.
BeaumierMBéchadeCDejardinO, et al.Is self-care dialysis associated with social deprivation in a universal health care system? a cohort study with data from the Renal epidemiology and information network registry. Nephrol Dial Transplant2020; 35(5): 861–869.
20.
MehrotraRSoohooMRivaraMB, et al.Racial and ethnic disparities in use of and outcomes with home dialysis in the United States. J Am Soc Nephrol2016; 27(7): 2123–2134.
21.
FilcDDavidovichNNovackL, et al.Is socioeconomic status associated with utilization of health care services in a single-payer universal health care system?Int J Equity Health2014; 13: 115.
22.
FraserSDSRoderickPJCaseyM, et al.Prevalence and associations of limited health literacy in chronic kidney disease: a systematic review. Nephrol Dial Transplant2013; 28(1): 129–137.
23.
PsaltopoulouTHatzisGPapageorgiouN, et al.Socioeconomic status and risk factors for cardiovascular disease: impact of dietary mediators. Hellenic J Cardiol2017; 58(1): 32–42.
24.
PornetCDelpierreCDejardinO, et al.Construction of an adaptable European transnational ecological deprivation index: the French version. J Epidemiol Community Health2012; 66(11): 982–989.
25.
GuillaumeEPornetCDejardinO, et al.Development of a cross-cultural deprivation index in five European countries. J Epidemiol Community Health2016; 70(5): 493–499.
26.
DriolletBBayerFChateletV, et al.Social deprivation is associated with poor kidney transplantation outcome in children. Kidney Int2019; 96(3): 769–776.
27.
ChâteletVBayat-MakoeiSVigneauC, et al.Renal transplantation outcome and social deprivation in the French healthcare system: a cohort study using the European deprivation index. Transplant Int2018; 31(10): 1089–1098.
28.
MarrónBOrtizAde SequeraP, et al.Impact of end-stage renal disease care in planned dialysis start and type of renal replacement therapy—a Spanish multicentre experience. Nephrol Dial Transplant2006; 21(suppl 2): ii51–55.
29.
ChenJHJohnsonDWWongG, et al.Associations between diabetes and sex with peritoneal dialysis technique and patient survival: results from the Australia and New Zealand dialysis and transplant registry cohort study. Perit Dial Int. 2020. DOI: 10.1177/0896860820918708.
30.
ThioCHLVartPKienekerLM, et al.Educational level and risk of chronic kidney disease: longitudinal data from the PREVEND study. Nephrol Dial Transplant2020;35(7):1211–1218.
31.
CouchoudCStengelBLandaisP, et al.The renal epidemiology and information network (REIN): a new registry for end-stage renal disease in France. Nephrol Dial Transplant2006; 21(2): 411–418.
32.
TemamSVarrasoRPornetC, et al.Ability of ecological deprivation indices to measure social inequalities in a French cohort. BMC Public Health2017; 17(1): 956.
33.
TennantPWGMurrayEJArnoldKF, et al.Use of directed acyclic graphs (DAGs) to identify confounders in applied health research: review and recommendations. Intl J Epidemiol2020; 50(2): dyaa213.
34.
ShrierIPlattRW. Reducing bias through directed acyclic graphs. BMC Med Res Methodol2008; 8: 70.
35.
KDIGO CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl2013; 3: 1–150.
36.
LangeTHansenKWSørensenR, et al.Applied mediation analyses: a review and tutorial. Epidemiol Health2017; 39: e2017035.
37.
SteenJLoeysTMoerkerkeB, et al.Package for flexible mediation analysis using natural effect models. J Stat Software2017; 76: 4452.
38.
DingPVanderweeleTJ. Sharp sensitivity bounds for mediation under unmeasured mediator-outcome confounding. Biometrika2016; 103(2): 483–490.
39.
MathurMBDingPRiddellCA, et al.Website and R package for computing E-values. Epidemiology2018; 29(5): e45–47.
40.
RubinDB. Multiple imputation for nonresponse in surveys. New York, NY: John Wiley & Sons, 1987.
41.
CaskeyFJRoderickPSteenkampR, et al.Social deprivation and survival on renal replacement therapy in England and Wales. Kidney Int2006; 70(12): 2134–2140.
42.
KesslerMFrimatLPanescuV, et al.Impact of nephrology referral on early and midterm outcomes in ESRD: epidémiologie de L’Insuffisance REnale chronique terminale en Lorraine (EPIREL): results of a 2-year, prospective, community-based study. Am J Kidney Dis2003; 42(3): 474–485.
43.
BelloAKPetersJRigbyJ, et al.Socioeconomic status and chronic kidney disease at presentation to a renal service in the United Kingdom. Clin J Am Soc Nephrol2008; 3(5): 1316–1323.
44.
ZengXLiuJTaoS, et al.Associations between socioeconomic status and chronic kidney disease: a meta-analysis. J Epidemiol Community Health2018; 72(4): 270–279.
45.
PatzerREMcClellanWM. Influence of race, ethnicity and socioeconomic status on kidney disease. Nat Rev Nephrol2012; 8(9): 533–541.
46.
MartinsDTareenNZadshirA, et al.The association of poverty with the prevalence of albuminuria: data from the third national health and nutrition examination survey (NHANES III). Am J Kidney Dis2006; 47(6): 965–971.
47.
HossainMPPalmerDGoyderE, et al.Association of deprivation with worse outcomes in chronic kidney disease: findings from a hospital-based cohort in the United Kingdom. Nephron Clin Pract2012;120(2): c59–c70.
48.
WardMM. Socioeconomic status and the incidence of ESRD. Am J Kidney Dis2008; 51(4): 563–572.
49.
LaunayLGuillotFGaillardD, et al.Methodology for building a geographical accessibility health index throughout metropolitan France. PLoS One2019; 14(8): e0221417.
50.
Société Francophone de Néphrologie Dialyse et Transplantation. Rapport sur la dialyse chronique en France en 2016. Néphrologie Thérapeutique2017; 13(2): 105–126.
51.
TaylorDMFraserSDSBradleyJA, et al.A Systematic review of the prevalence and associations of limited health literacy in CKD. Clin J Am Soc Nephrol2017; 12(7): 1070–1084.
52.
MoronySFlynnMMcCafferyKJ, et al.Readability of written materials for CKD patients: a systematic review. Am J Kidney Dis2015; 65(6): 842–850.
53.
WalkerRCHowardKTongA, et al.The economic considerations of patients and caregivers in choice of dialysis modality: economic considerations in dialysis. Hemodial Int2016; 20(4): 634–642.
54.
MendelssohnDCMullaneySRJungB, et al.What do American nephrologists think about dialysis modality selection?Am J Kidney Dis2001; 37(1): 22–29.
55.
SukulNZhaoJFullerDS, et al.Patient-reported advantages and disadvantages of peritoneal dialysis: results from the PDOPPS. BMC Nephrol2019; 20(1): 116.
56.
BryereJPornetCCopinN, et al.Assessment of the ecological bias of seven aggregate social deprivation indices. BMC Public Health2017; 17(1): 86.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
