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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 
Abstract : 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.
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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, Elsevier, 2021, 11p. ⟨10.1016/j.ekir.2021.12.015⟩. ⟨hal-03563361⟩



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