Lucy A Plumb1,2, Manish D Sinha3,4, Anna Casula2, Carol D Inward5, Stephen D Marks6,7, Fergus J Caskey8,9, Yoav Ben-Shlomo8,10. 1. Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom lucy.plumb@bristol.ac.uk. 2. United Kingdom Renal Registry, The Renal Association, Bristol, United Kingdom. 3. Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys and St Thomas' National Health Service Foundation Trust, London, United Kingdom. 4. King's British Heart Foundation Centre, King's College London, London, United Kingdom. 5. Department of Paediatric Nephrology, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, United Kingdom. 6. Department of Paediatric Nephrology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom. 7. National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom. 8. Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom. 9. Department of Renal Medicine, North Bristol National Health Service Trust, Bristol, United Kingdom. 10. The National Institute for Health Research Applied Research Collaboration West, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, United Kingdom.
Abstract
BACKGROUND AND OBJECTIVES: Pre-emptive kidney transplantation is advocated as best practice for children with kidney failure who are transplant eligible; however, it is limited by late presentation. We aimed to determine whether socioeconomic deprivation and/or geographic location (distance to the center and rural/urban residence) are associated with late presentation, and to what degree these factors could explain differences in accessing pre-emptive transplantation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A cohort study using prospectively collected United Kingdom Renal Registry and National Health Service Blood and Transplant data from January 1, 1996 to December 31, 2016 was performed. We included children aged >3 months to ≤16 years at the start of KRT. Multivariable logistic regression models were used to determine associations between the above exposures and our outcomes: late presentation (defined as starting KRT within 90 days of first nephrology review) and pre-emptive transplantation, with a priori specified covariates. RESULTS: Analysis was performed on 2160 children (41% females), with a median age of 3.8 years (interquartile range, 0.2-9.9 years) at first nephrology review. Excluding missing data, 478 were late presenters (24%); 565 (26%) underwent pre-emptive transplantation, none of whom were late presenting. No association was seen between distance or socioeconomic deprivation with late presentation, in crude or adjusted analyses. Excluding late presenters, greater area affluence was associated with higher odds of pre-emptive transplantation, (odds ratio, 1.20 per quintile greater affluence; 95% confidence interval, 1.10 to 1.31), with children of South Asian (odds ratio, 0.52; 95% confidence interval, 0.36 to 0.76) or Black ethnicity (odds ratio, 0.31; 95% confidence interval, 0.12 to 0.80) less likely to receive one. A longer distance to the center was associated with pre-emptive transplantation on crude analyses; however, this relationship was attenuated (odds ratio, 1.02 per 10 km; 95% confidence interval, 0.99 to 1.05) in the multivariable model. CONCLUSIONS: Socioeconomic deprivation or geographic location are not associated with late presentation in children in the United Kingdom. Geographic location was not independently associated with pre-emptive transplantation; however, children from more affluent areas were more likely to receive a pre-emptive transplant.
BACKGROUND AND OBJECTIVES: Pre-emptive kidney transplantation is advocated as best practice for children with kidney failure who are transplant eligible; however, it is limited by late presentation. We aimed to determine whether socioeconomic deprivation and/or geographic location (distance to the center and rural/urban residence) are associated with late presentation, and to what degree these factors could explain differences in accessing pre-emptive transplantation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A cohort study using prospectively collected United Kingdom Renal Registry and National Health Service Blood and Transplant data from January 1, 1996 to December 31, 2016 was performed. We included children aged >3 months to ≤16 years at the start of KRT. Multivariable logistic regression models were used to determine associations between the above exposures and our outcomes: late presentation (defined as starting KRT within 90 days of first nephrology review) and pre-emptive transplantation, with a priori specified covariates. RESULTS: Analysis was performed on 2160 children (41% females), with a median age of 3.8 years (interquartile range, 0.2-9.9 years) at first nephrology review. Excluding missing data, 478 were late presenters (24%); 565 (26%) underwent pre-emptive transplantation, none of whom were late presenting. No association was seen between distance or socioeconomic deprivation with late presentation, in crude or adjusted analyses. Excluding late presenters, greater area affluence was associated with higher odds of pre-emptive transplantation, (odds ratio, 1.20 per quintile greater affluence; 95% confidence interval, 1.10 to 1.31), with children of South Asian (odds ratio, 0.52; 95% confidence interval, 0.36 to 0.76) or Black ethnicity (odds ratio, 0.31; 95% confidence interval, 0.12 to 0.80) less likely to receive one. A longer distance to the center was associated with pre-emptive transplantation on crude analyses; however, this relationship was attenuated (odds ratio, 1.02 per 10 km; 95% confidence interval, 0.99 to 1.05) in the multivariable model. CONCLUSIONS: Socioeconomic deprivation or geographic location are not associated with late presentation in children in the United Kingdom. Geographic location was not independently associated with pre-emptive transplantation; however, children from more affluent areas were more likely to receive a pre-emptive transplant.
Authors: Udaya Udayaraj; Yoav Ben-Shlomo; Paul Roderick; Anna Casula; Chris Dudley; Dave Collett; David Ansell; Charles Tomson; Fergus Caskey Journal: Transplantation Date: 2012-03-27 Impact factor: 4.939
Authors: Steven J Chadban; Curie Ahn; David A Axelrod; Bethany J Foster; Bertram L Kasiske; Vijah Kher; Deepali Kumar; Rainer Oberbauer; Julio Pascual; Helen L Pilmore; James R Rodrigue; Dorry L Segev; Neil S Sheerin; Kathryn J Tinckam; Germaine Wong; Gregory A Knoll Journal: Transplantation Date: 2020-04 Impact factor: 4.939
Authors: Richard G Kyle; Marina Kukanova; Malcolm Campbell; Ingrid Wolfe; Peter Powell; Peter Callery Journal: Arch Dis Child Date: 2010-09-29 Impact factor: 3.791
Authors: R E Patzer; S Amaral; M Klein; N Kutner; J P Perryman; J A Gazmararian; W M McClellan Journal: Am J Transplant Date: 2012-01-06 Impact factor: 8.086
Authors: Louise M Moist; Jennifer L Bragg-Gresham; Ronald L Pisoni; Rajiv Saran; Takashi Akiba; Stefan H Jacobson; Shunichi Fukuhara; Donna L Mapes; Hugh C Rayner; Akira Saito; Friedrich K Port Journal: Am J Kidney Dis Date: 2008-03-03 Impact factor: 8.860
Authors: Alexander J Hamilton; Fergus J Caskey; Anna Casula; Yoav Ben-Shlomo; Carol D Inward Journal: Am J Kidney Dis Date: 2018-10-04 Impact factor: 8.860
Authors: David C Taylor-Robinson; Rosalind L Smyth; Peter J Diggle; Margaret Whitehead Journal: Lancet Respir Med Date: 2013-01-30 Impact factor: 30.700
Authors: Duvuru Geetha; Andreas Kronbichler; Megan Rutter; Divya Bajpai; Steven Menez; Annemarie Weissenbacher; Shuchi Anand; Eugene Lin; Nicholas Carlson; Stephen Sozio; Kevin Fowler; Ray Bignall; Kathryn Ducharlet; Elliot K Tannor; Eranga Wijewickrama; Muhammad I A Hafidz; Vladimir Tesar; Robert Hoover; Deidra Crews; Charles Varnell; Lara Danziger-Isakov; Vivekanand Jha; Sumit Mohan; Chirag Parikh; Valerie Luyckx Journal: Nat Rev Nephrol Date: 2022-08-24 Impact factor: 42.439