Socio-economic disparity, access to care and patient-relevant outcomes after kidney allograft failure.
home dialysis
kidney allograft failure
mortality
pre-emptive transplant
socio-economic status
Journal
Transplant international : official journal of the European Society for Organ Transplantation
ISSN: 1432-2277
Titre abrégé: Transpl Int
Pays: Switzerland
ID NLM: 8908516
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
revised:
16
06
2021
received:
17
11
2020
accepted:
11
07
2021
pubmed:
3
8
2021
medline:
15
12
2021
entrez:
2
8
2021
Statut:
ppublish
Résumé
Social disparity is a major impediment to optimal health outcomes after kidney transplantation. In this study, we aimed to define the association between socio-economic status (SES) disparities and patient-relevant outcomes after kidney allograft failure. Using data from the Australia and New Zealand Dialysis and Transplant registry, we included patients with failed first-kidney allografts in Australia between 2005 and 2017. The association between residential postcode-derived SES in quintiles (quintile 1-most disadvantaged areas, quintile 5-most advantaged areas) with uptake of home dialysis (peritoneal or home haemodialysis) within the first 12-months post-allograft failure, repeat transplantation and death on dialysis were examined using competing-risk analysis. Of 2175 patients who had experienced first allograft failure, 417(19%) and 505(23%) patients were of SES quintiles 1 and 5, respectively. Compared to patients of quintile 5, quintile 1 patients were less likely to receive repeat transplants (adjusted subdistributional hazard ratio [SHR] 0.70,95%CI 0.55-0.89) and were more likely to die on dialysis (1.37 [1.04-1.81]), but there was no association with the uptake of home dialysis (1.02 [0.77-1.35]). Low SES may have a negative effect on outcomes post-allograft failure and further research is required into how best to mitigate this. However, small-scale variation within SES cannot be accounted for in this study.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2329-2340Subventions
Organisme : Wellcome Trust
ID : 102538
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 102538
Pays : United Kingdom
Informations de copyright
© 2021 Steunstichting ESOT. Published by John Wiley & Sons Ltd.
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