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Kidney Week

Abstract: TH-PO782

The Effect of Socioeconomic Status and Distance to Specialist Hospital on Access to Paediatric Nephrology Care in England

Session Information

  • Pediatric CKD
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Plumb, Lucy A., University of Bristol, Bristol, United Kingdom
  • Casula, Anna, UK Renal Registry, Bristol, United Kingdom
  • Sinha, Manish, Evelina London Children's Hospital, Guys & St Thomas'' Foundation Hospitals NHS Trust, London, United Kingdom
  • Inward, Carol D., Bristol Royal Hospital for Children, Bristol, United Kingdom
  • Ben-shlomo, Yoav, Population Health Sciences, Bristol, United Kingdom
  • Caskey, Fergus J., Population Health Sciences, Bristol, United Kingdom
Background

For children with end-stage kidney disease (ESKD), transplantation is the preferred treatment of choice, offering improved survival and quality of life. Pre-emptive transplantation (PET) is advocated as best practice. Access however is limited by late presentation of kidney disease, defined as starting renal replacement therapy (RRT) within 90 days of first presentation to a nephrologist. In this study we aim to explore whether socio-economic status (SES) or geographical remoteness from centre are associated with 1) timing of presentation to nephrology services and 2) access to PET.

Methods

A cohort study using UK Renal Registry and NHS Blood & Transplant data from 01/01/1996-31/12/2016 was performed. Children in England aged up to 16 years receiving chronic RRT were included. Exposures of interest were distance from home to paediatric nephrology unit (per 10km) and SES, as measured by the UK Index of Multiple Deprivation (IMD) quintiles. Study outcomes were 1) late presentation and 2) PET (transplant recorded as first RRT modality). Late presenters were excluded from the PET analysis. Multivariable logistic regression analyses were performed, covariates were determined a priori and included age, gender, ethnicity, renal disease and time-period.

Results

During the study-period, 1856 children received RRT (776 females, 41.8%), with a median age of 3.8 years at presentation. Of these, 426 were late presenters (24.4%); 37.4% of non-late presenters (n=1271 without missing data) underwent PET. No association was seen between distance or SES with late presentation, on crude or adjusted analyses. As SES increased, odds of PET increased by 12% per quintile (OR 1.12, 95% CI 1.02, 1.23, p=0.02). Similar findings were seen among White patients only to exclude any effect of ethnic minorities. Increasing distance from centre was strongly associated with PET in crude analyses, however this effect was markedly attenuated (p=0.16) in the fully adjusted model.

Conclusion

SES or distance from centre are not associated with late presentation of childhood kidney disease. Access to PET increases with SES. Clinicians should be aware of this finding and ensure timely support is provided to disadvantaged families in the pre-dialysis phase to ensure optimum access to early transplantation.

Funding

  • Government Support - Non-U.S.