ESPN 53rd Annual Meeting

ESPN 2021


 
Social deprivation at initiation of kidney replacement therapy 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 GWENAëLLE ROUSSEY 9 STéPHANIE TELLIER 10 MARC FILA 11 ARIANE ZALOSZYC 12 LUDIVINE LAUNAY 13 JéRôME HARAMBAT 14 KAREN LEFFONDRE 1

1- UNIVERSITY OF BORDEAUX, ISPED, CENTRE INSERM U1219-BORDEAUX POPULATION HEALTH RESEARCH, BORDEAUX, FRANCE
2- AGENCE DE LA BIOMéDECINE, REIN REGISTRY, LA PLAINE-SAINT DENIS, FRANCE
3- PEDIATRIC NEPHROLOGY UNIT, ROBERT DEBRé UNIVERSITY HOSPITAL, ASSISTANCE PUBLIQUE-HôPITAUX DE PARIS, PARIS, FRANCE
4- PEDIATRIC NEPHROLOGY UNIT, CENTRE DE RéFéRENCE DES MALADIES RéNALES RARES, NECKER-ENFANTS MALADES UNIVERSITY HOSPITAL, ASSISTANCE PUBLIQUE-HôPITAUX DE PARIS, PARIS, FRANCE
5- PEDIATRIC NEPHROLOGY UNIT, CENTRE DE RéFéRENCE DES MALADIES RéNALES RARES, FEMME MèRE ENFANTS UNNIVERSITY HOSPITAL, HOSPICES CIVILS DE LYON, BRON, FRANCE
6- PEDIATRIC NEPHROLOGY UNIT, LA TIMONE HOSPITAL, ASSISTANCE PUBLIQUE-HôPITAUX DE MARSEILLE, MARSEILLE, FRANCE
7- PEDIATRIC NEPHROLOGY UNIT, TROUSSEAU UNIVERSITY HOSPITAL, ASSISTANCE PUBLIQUE-HôPITAUX DE PARIS, PARIS, FRANCE
8- PEDIATRIC NEPHROLOGY UNIT, LILLE UNIVERSITY HOSPITAL, LILLE, FRANCE
9- PEDIATRIC NEPHROLOGY UNIT, NANTES UNIVERSITY HOSPITAL, NANTES, FRANCE
10- PEDIATRIC NEPHROLOGY UNIT, CENTRE DE RéFéRENCE DES MALADIES RéNALES RARES, TOULOUSE UNIVERSITY HOSPITAL, TOULOUSE, FRANCE
11- PEDIATRIC NEPHROLOGY UNIT, MONTPELLIER UNIVERSITY HOSPITAL, MONTPELLIER, FRANCE
12- PEDIATRIC NEPHROLOGY UNIT, STRASBOURG UNIVERSITY HOSPITAL, STRASBOURG, FRANCE
13- INSERM-UCN U1086 ANTICIPE, CENTRE DE LUTTE CONTRE LE CANCER FRANÇOIS BACLESSE, CAEN, FRANCE
14- PEDIATRIC NEPHROLOGY UNIT, PELLEGRIN-ENFANTS HOSPITAL, BORDEAUX UNIVERSITY HOSPITAL, BORDEAUX, FRANCE
 
Introduction:

Socioeconomic status is recognized as an important determinant of kidney health. We aimed to assess the association of social deprivation with different indicators at kidney replacement therapy (KRT) initiation in the French pediatric population.

Material and methods:

All end-stage kidney disease (ESKD) patients who started KRT before 20 years old in France between 2002 and 2015 were included. We investigated different indicators at KRT initiation: KRT modality (dialysis vs. pre-emptive transplantation), dialysis modality (hemodialysis [HD] vs. peritoneal dialysis [PD]), urgent vs. planned start of dialysis, use of catheter vs. fistula for HD vascular access), and late referral to a nephrologist. An ecological index, the European Deprivation Index (EDI), was used as a proxy for social deprivation.

Results:

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 that pediatric ESKD patients come from a more socially deprived background. Social deprivation was significantly associated with the initial modality of KRT. Patients from the most deprived areas were more likely to initiate KRT with dialysis (adjusted OR 1.88; 95%CI 1.15-3.07) than those from the least deprived areas, and more often with HD than with PD. Among HD patients, the odds of starting treatment in emergency with a catheter was two-fold higher for the most deprived compared to the least deprived children (adjusted OR 2.08; 95%CI 1.07-4.04). There was a trend towards later referral in patients from the most deprived areas.

Conclusions:

Children from the most deprived areas have lower access to pre-emptive kidney transplantation, lower access to PD, have more urgent initiation of HD with a catheter, and tend to be later referred to a nephrologist.