Abstract: PUB136
Socioeconomic Disparities in Initiation of Renal Replacement Therapy (RRT): A Comprehensive Review
Session Information
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
Authors
- Asaolu, Gideon, Northeast Georgia Health System Inc, Gainesville, Georgia, United States
- Chijioke, Chidinma Blossom, Saint Clare's Health System, Denville, New Jersey, United States
- Aggarwal, Deepak K., Northeast Georgia Health System Inc, Gainesville, Georgia, United States
Background
Socioeconomic disparities arise from an unequal distribution of resources among different groups within a society. It has a lot of influence, including the initiation and outcomes of RRT, which includes dialysis and kidney transplantation, among patients with end-stage renal disease (ESRD). Marginalized populations, particularly racial and ethnic minorities, are disproportionately affected.
Methods
A comprehensive review of existing literature was conducted, focusing on studies that examine the relationship between socioeconomic status and the timing of RRT initiation. I used peer-reviewed studies published in PubMed and MEDLINE between 2010 and 2024. Keywords included "renal replacement therapy," "dialysis initiation," "kidney transplantation," "health disparities," and "socioeconomic status." Inclusion criteria focused on U.S.-based cohort studies, registry data, and systematic reviews. Studies addressing racial and ethnic disparities, health policy impacts, and social determinants of health in the ESRD population were prioritized.
Results
Individuals from lower socioeconomic backgrounds are more likely to experience delayed initiation of RRT. Factors contributing include, limited access to healthcare facilities, lack of income and insurance coverage, education, geographic access. These patients get late evaluation for vascular access and start sub-standard dialysis treatment. According to the USRDS, 20% of black patients receiving dialysis are waitlisted within a year for transplant, 13% of these patients receive organs from living donors. 25% of Hispanic patients receiving dialysis are waitlisted within a year for transplant. In comparison, 35 - 40% of the white population receiving dialysis are waitlisted within a year, and 38 - 40% receive organs from living donors. These disparities are compounded by systemic factors such as discrimination, cultural barriers, language barriers, and mistrust of the healthcare system.
Conclusion
Addressing socioeconomic differences is crucial to ensure the timely initiation of RRT. The impact of late RRT initiation includes increased mortality and morbidity, and poorer quality of life. Strategies such as early follow-up from the primary care level, early identification and referral, improving healthcare access, equity in transplant access, enhancing patient education would improve patient outcomes.