Interaction between socioeconomic deprivation and likelihood of pre-emptive transplantation: influence of competing risks and referral characteristics - a retrospective study

Gillis, Keith; Lees, Jennifer S; Ralston, Maximilian; Glen, J.; Stevenson, Karen; McManus, Siobhan K.; Geddes, Colin C.; Clancy, Marc; Traynor, Jamie P.; Mark, Patrick B.

doi:10.1111/tri.13336

Cited by 6 publications

(8 citation statements)

References 27 publications

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“…22 We also found that people of lower SES are more likely to have CKD after age and sex adjustment. This is an important finding given that individuals of lower SES have greater mortality due to comorbid factors which then predict mortality on an independent basis, 23 including obesity and associated cardiovascular risk factors. 17 Adjusting for age, sex, and deprivation reversed the direction of association for PD and dementia so both had odds-ratios <1.…”

Section: Discussionmentioning

confidence: 87%

Comorbidity in chronic kidney disease: a large cross-sectional study of prevalence in Scottish primary care

et al. 2020

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Background: Chronic kidney disease (CKD) is commonly comorbid with hypertension, diabetes and cardiovascular disease (CVD). However, the extent of comorbidity in CKD across a wider range of conditions is not well documented. Aim: To ascertain the prevalence of comorbidity (across 39 physical and mental health comorbidities) in adults aged 25 years and over with CKD in a large nationally representative primary care population. Design and Setting: Cross-sectional analysis of a primary care dataset representing 1,274,374 adults in Scotland. Method: Secondary analysis of general practice electronic medical record data. Comparison was made with the entire population without CKD, standardised for age, sex, and socioeconomic status (SES). Results: A total of 98.2% of adults with CKD had at least one comorbidity (vs. 51.8% in controls). After adjustment for age, sex, and deprivation, people with CKD were more likely to have 1-3 conditions (OR 11.2, 95% CI 10.3-12.2), 4-6 conditions (OR 24.9, 95% CI 22.9-27.0), and ≥7 conditions (OR 38.9, 95% CI 35.6-42.6. Furthermore, all concordant (7 out of 7) and the majority of discordant physical health conditions (17 out of 24) and mental health conditions (6 out of 8) had significantly positive associations with CKD after adjustment. Conclusion: CKD is associated with extreme comorbidity, across a wide range of mental and physical conditions. Routine care for people with CKD should include recognition and management of comorbidities and clinical guidelines should support clinicians to do this.

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Section: Discussionmentioning

confidence: 87%

Comorbidity in chronic kidney disease: a large cross-sectional study of prevalence in Scottish primary care

et al. 2020

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“…While living donor kidney transplantation (LDKT) is the best treatment option with chronic kidney disease (CKD) in terms of survival and quality of life [ 1 , 2 ], research has shown that there is inequality in access to LDKT [ 3 , 4 ]. A number of modifiable factors, such as patients’ knowledge on kidney replacement therapy (KRT), communication with family and friends about KRT, and cultural sensitivity of health care professionals are independently related to the access to LDKT [ 5 , 6 ]. A home‐based educational intervention has been developed to address these factors.…”

Section: Introductionmentioning

confidence: 99%

Implementation of the kidney team at home intervention: Evaluating generalizability, implementation process, and effects

et al. 2021

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Summary Research has shown that a home‐based educational intervention for patients with chronic kidney disease results in better knowledge and communication, and more living donor kidney transplantations (LDKT). Implementation research in the field of renal care is almost nonexistent. The aims of this study were (1) to demonstrate generalizability, (2) evaluate the implementation process, and (3) to assess the relationship of intervention effects on LDKT‐activity. Eight hospitals participated in the project. Patients eligible for all kidney replacement therapies (KRT) were invited to participate. Effect outcomes were KRT‐knowledge and KRT‐communication, and treatment choice. Feasibility, fidelity, and intervention costs were assessed as part of the process evaluation. Three hundred and thirty‐two patients completed the intervention. There was a significant increase in KRT‐knowledge and KRT‐communication among participants. One hundred and twenty‐nine out of 332 patients (39%) had LDKT‐activity, which was in line with the results of the clinical trials. Protocol adherence, knowledge, and age were correlated with LDKT‐activity. This unique implementation study shows that the results in practice are comparable to the previous trials, and show that the intervention can be implemented, while maintaining quality. Results from the project resulted in the uptake of the intervention in standard care. We urge other countries to investigate the uptake of the intervention.

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“…(4) While living-donor transplantations became more common among Jewish children, Arab and Druze children did not demonstrate this trend, resulting in a prolonged absolute waiting time for kidney transplantation. (5) We observed a poorer prognosis among infants on dialysis, although their prognosis improved significantly over the study period. We also observed poorer prognosis among minority groups.…”

Section: Discussionmentioning

confidence: 57%

“…Recent studies demonstrated specifically the adverse effect of low socioeconomic status and immigration on the likelihood to undergo living-donor kidney transplantation. 4–7…”

Section: Introductionmentioning

confidence: 99%

Dialysis in Israeli Children between 1990 and 2020: Trends and International Comparisons

Regev-Epstein

Frishberg

Davidovits

et al. 2023

CJASN

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Background Childhood kidney failure is a rare condition with worldwide clinical variability. We used a nationwide multicenter analysis to study the pretransplant course of the entire Israeli pediatric kidney failure population over 30 years.Methods In this nationwide, population-based, historical cohort study, we analyzed medical and demographic data of all children treated with KRT and reported to the Israeli kidney failure registry in 1990-2020. Statistical analysis was performed with incidence rate corrected for age, ethnicity, and calendar year, using the appropriate age-related general population as denominator. ResultsDuring the last 30 years, childhood incidence of kidney failure decreased. Average incidence in 2015-2019 was 9.1 cases per million age-related population (pmarp). Arab and Druze children exhibited higher kidney failure incidence rates than Jewish children (18.4 versus 7.0 cases pmarp for minorities versus Jews). The most common kidney failure etiologies among Arab and Jewish children were congenital anomalies of the kidney and urinary tract (approximately 27%), followed by cystic kidney diseases among Arab children (13%) and glomerulonephritis among Jewish children (16%). The most common etiology among Druze children was primary hyperoxaluria type 1 (33%). Israel's national health insurance provides access to primary health care to all citizens. Accordingly, waiting time for deceased-donor transplantation was equal between all ethnicities. Living-donor kidney transplantation rates among minority populations remained low in comparison with Jews over the entire study period. Although all patient groups demonstrated improvement in survival, overall survival rates were mainly etiology dependent.Conclusions In Israel, Arab and Druze children had a higher incidence of kidney failure, a unique etiological distribution, and a lower rate of living-donor kidney transplantations compared with Jewish children.

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Interaction between socioeconomic deprivation and likelihood of pre-emptive transplantation: influence of competing risks and referral characteristics - a retrospective study

Cited by 6 publications

References 27 publications

Comorbidity in chronic kidney disease: a large cross-sectional study of prevalence in Scottish primary care

Comorbidity in chronic kidney disease: a large cross-sectional study of prevalence in Scottish primary care

Implementation of the kidney team at home intervention: Evaluating generalizability, implementation process, and effects

Dialysis in Israeli Children between 1990 and 2020: Trends and International Comparisons

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