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Pediatric Nephrology

, Volume 31, Issue 6, pp 1011–1019 | Cite as

The impact of socioeconomic status and geographic remoteness on access to pre-emptive kidney transplantation and transplant outcomes among children

  • Anna Francis
  • Madeleine Didsbury
  • Wai H. Lim
  • Siah Kim
  • Sarah White
  • Jonathan C. Craig
  • Germaine WongEmail author
Original Article

Abstract

Background

Low socioeconomic status (SES) and geographic disparity have been associated with worse outcomes and poorer access to pre-emptive transplantation in the adult end-stage kidney disease (ESKD) population, but little is known about their impact in children with ESKD. The aim of our study was to determine whether access to pre-emptive transplantation and transplant outcomes differ according to SES and geographic remoteness in Australia.

Methods

Using data from the Australia and New Zealand Dialysis and Transplant Registry (1993–2012), we compared access to pre-emptive transplantation, the risk of acute rejection and graft failure, based on SES and geographic remoteness among Australian children with ESKD (≤18 years), using adjusted logistic and Cox proportional hazard modelling.

Results

Of the 768 children who commenced renal replacement therapy, 389 (50.5 %) received living donor kidney transplants and 28.5 % of these (111/389) were pre-emptive. There was no significant association between SES quintiles and access to pre-emptive transplantation, acute rejection or allograft failure. Children residing in regional or remote areas were 35 % less likely to receive a pre-emptive transplant compared to those living in major cities [adjusted odds ratio (OR) 0.65, 95 % confidence interval (CI) 0.45–1.0]. There was no significant association between geographic disparity and acute rejection (adjusted OR 1.03, 95 % CI 0.68–1.57) or graft loss (adjusted hazard ratio 1.05, 95 % CI 0.74–1.41).

Conclusions

In Australia, children from regional or remote regions are much less likely to receive pre-emptive kidney transplantation. Strategies such as improved access to nephrology services through expanding the scope of outreach clinics, and support for regional paediatricians to promote early referral may ameliorate this inequity.

Keywords

Kidney transplantation Pre-emptive living donor transplantation Survival analyses Paediatrics Geographic remoteness Socioeconomic factors 

Notes

Author contributions

AF participated in the writing of the paper and data analysis, MD, SK and JCC participated in the writing of the paper, WHL participated in research design and the writing of the paper, and GW participated in research design, the performance of the research, data analyses and the writing of the paper

Compliance with ethical standards

Due to the retrospective nature of this study neither individual parental consent nor internal review board approval were required

Conflict of interest

The authors declare no conflicts of interest.

Supplementary material

467_2015_3279_MOESM1_ESM.docx (58 kb)
ESM 1 (DOCX 58.5 kb)

References

  1. 1.
    McDonald SP, Craig JC, Australian, New Zealand Paediatric Nephrology A (2004) Long-term survival of children with end-stage renal disease. N Engl J Med 350:2654–2662CrossRefPubMedGoogle Scholar
  2. 2.
    Laskin BL, Mitsnefes MM, Dahhou M, Zhang X, Foster BJ (2015) The mortality risk with graft function has decreased among children receiving a first kidney transplant in the United States. Kidney Int 87:575–583CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Crittenden MR, Holliday MA, Piel CF, Potter DE (1985) Intellectual development of children with renal insufficiency and end stage disease. Int J Pediatr Nephrol 6:275–280PubMedGoogle Scholar
  4. 4.
    Groothoff JW, Grootenhuis M, Dommerholt A, Gruppen MP, Offringa M, Heymans HS (2002) Impaired cognition and schooling in adults with end stage renal disease since childhood. Arch Dis Child 87:380–385CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Groothoff JW, Grootenhuis MA, Offringa M, Stronks K, Hutten GJ, Heymans HS (2005) Social consequences in adult life of end-stage renal disease in childhood. J Pediatr 146:512–517CrossRefPubMedGoogle Scholar
  6. 6.
    Vats AN, Donaldson L, Fine RN, Chavers BM (2000) Pretransplant dialysis status and outcome of renal transplantation in North American Children: a Naprtcs study 12. Transplantation 69:1414–1419CrossRefPubMedGoogle Scholar
  7. 7.
    Franke D, Thomas L, Steffens R, Pavičić L, Gellermann J, Froede K, Querfeld U, Haffner D, Živičnjak M (2014) Patterns of growth after kidney transplantation among children with ESRD. Clin J Am Soc Nephrol 10:127–134CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Foster BJ, Dahhou M, Zhang X, Platt RW, Hanley JA (2011) Change in mortality risk over time in young kidney transplant recipients. Am J Transplant 11:2432–2442CrossRefPubMedGoogle Scholar
  9. 9.
    Smith JM, Martz K, Blydt-Hansen TD (2013) Pediatric kidney transplant practice patterns and outcome benchmarks, 1987–2010: a report of the North American Pediatric Renal Trials and Collaborative Studies. Pediatr Transplant 17:149–157CrossRefPubMedGoogle Scholar
  10. 10.
    Patzer RE, Amaral S, Wasse H, Volkova N, Kleinbaum D, McClellan WM (2009) Neighborhood poverty and racial disparities in kidney transplant waitlisting. J Am Soc Nephrol 20:1333–1340CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Axelrod DA, Dzebisashvili N, Schnitzler MA, Salvalaggio PR, Segev DL, Gentry SE, Tuttle-Newhall J, Lentine KL (2010) The interplay of socioeconomic status, distance to center, and interdonor service area travel on kidney transplant access and outcomes. Clin J Am Soc Nephrol 5:2276–2288CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Gill J, Dong J, Rose C, Johnston O, Landsberg D, Gill J (2013) The effect of race and income on living kidney donation in the United States. J Am Soc Nephrol 24:1872–1879CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Gore JL, Danovitch GM, Litwin MS, Pham PT, Singer JS (2009) Disparities in the utilization of live donor renal transplantation. Am J Transplant 9:1124–1133CrossRefPubMedGoogle Scholar
  14. 14.
    Keith D, Ashby VB, Port FK, Leichtman AB (2008) Insurance type and minority status associated with large disparities in prelisting dialysis among candidates for kidney transplantation. Clin J Am Soc Nephrol 3:463–470CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Grace BS, Clayton PA, Cass A, McDonald SP (2013) Transplantation rates for living- but not deceased-donor kidneys vary with socioeconomic status in Australia. Kidney Int 83:138–145CrossRefPubMedGoogle Scholar
  16. 16.
    Satayathum S, Pisoni RL, McCullough KP, Merion RM, Wikstrom B, Levin N, Chen K, Wolfe RA, Goodkin DA, Piera L, Asano Y, Kurokawa K, Fukuhara S, Held PJ, Port FK (2005) Kidney transplantation and wait-listing rates from the international Dialysis Outcomes and Practice Patterns Study (DOPPS). Kidney Int 68:330–337CrossRefPubMedGoogle Scholar
  17. 17.
    Goldfarb-Rumyantzev AS, Koford JK, Baird BC, Chelamcharla M, Habib AN, Wang BJ, Lin SJ, Shihab F, Isaacs RB (2006) Role of socioeconomic status in kidney transplant outcome. Clin J Am Soc Nephrol 1:313–322CrossRefPubMedGoogle Scholar
  18. 18.
    Patzer RE, Amaral S, Klein M, Kutner N, Perryman JP, Gazmararian JA, McClellan WM (2012) Racial disparities in pediatric access to kidney transplantation: does socioeconomic status play a role? Am J Transplant 12:369–378CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Omoloja A, Stolfi A, Mitsnefes M (2006) Racial differences in pediatric renal transplantation-24-year single center experience. J Natl Med Assoc 98:154–157PubMedPubMedCentralGoogle Scholar
  20. 20.
    Patzer RE, Sayed BA, Kutner N, McClellan WM, Amaral S (2013) Racial and ethnic differences in pediatric access to pre-emptive kidney transplantation in the United States. Am J Transplant 13:1769–1781CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Tromp WF, Cransberg K, van der Lee JH, Bouts AH, Collard L, Van Damme-Lombaerts R, Godefroid N, Van Hoeck KJ, Koster-Kamphuis L, Lilien MR, Raes A, Ranguelov N, Groothoff JW (2012) Fewer pre-emptive renal transplantations and more rejections in immigrant children compared to native Dutch and Belgian children. Nephrol Dial Transplant 27:2588–2593CrossRefPubMedGoogle Scholar
  22. 22.
    Mongeau JG, Clermont MJ, Robitaille P, Plante A, Jequier JC, Godbout C, Guertin MC, Beaulieu MA, Sarrazin F (1997) Study of psychosocial parameters related to the survival rate of renal transplantation in children. Pediatr Nephrol 11:542–546CrossRefPubMedGoogle Scholar
  23. 23.
    Oztek FZ, Ipsiroglu O, Mueller T, Aufricht C (2009) Outcome after renal transplantation in children from native and immigrant families in Austria. Eur J Pediatr 168:11–16CrossRefPubMedGoogle Scholar
  24. 24.
    Grace BS, Kara T, Kennedy SE, McDonald SP (2014) Racial disparities in pediatric kidney transplantation in New Zealand. Pediatr Transplant 18:689–697CrossRefPubMedGoogle Scholar
  25. 25.
    Australian Bureau of Statistics (2006) Australian Standard Geographical Classification 2006. Available at: www.abs.gov.au
  26. 26.
    Dudley CR, Johnson RJ, Thomas HL, Ravanan R, Ansell D (2009) Factors that influence access to the national renal transplant waiting list. Transplantation 88:96–102CrossRefPubMedGoogle Scholar
  27. 27.
    Begaj I, Khosla S, Ray D, Sharif A (2013) Socioeconomic deprivation is independently associated with mortality post kidney transplantation. Kidney Int 84:803–809CrossRefPubMedGoogle Scholar
  28. 28.
    Udayaraj U, Ben-Shlomo Y, Roderick P, Casula A, Dudley C, Collett D, Ansell D, Tomson C, Caskey F (2012) Social deprivation, ethnicity, and uptake of living kidney donor transplantation in the United Kingdom. Transplantation 93:610–616PubMedGoogle Scholar
  29. 29.
    Roodnat JI, Laging M, Massey EK, Kho M, Kal-van Gestel JA, Ijzermans JN, van de Wetering J, Weimar W (2012) Accumulation of unfavorable clinical and socioeconomic factors precludes living donor kidney transplantation. Transplantation 93:518–523CrossRefPubMedGoogle Scholar
  30. 30.
    Kasiske BL, Snyder JJ, Matas AJ, Ellison MD, Gill JS, Kausz AT (2002) Preemptive kidney transplantation: the advantage and the advantaged. J Am Soc Nephrol 13:1358–1364Google Scholar
  31. 31.
    Samuel SM, Hemmelgarn B, Nettel-Aguirre A, Foster B, Soo A, Alexander RT, Tonelli M, Pediatric Renal Outcomes Canada G (2012) Association between residence location and likelihood of transplantation among pediatric dialysis patients. Pediatr Transplant 16:735–741CrossRefPubMedGoogle Scholar
  32. 32.
    Alexander G, Sehgal AR (1998) Barriers to cadaveric renal transplantation among blacks, women, and the poor. JAMA 280:1148–1152CrossRefPubMedGoogle Scholar
  33. 33.
    Bailey PK, Tomson CR, Ben-Shlomo Y (2013) Study of living kidney donor-recipient relationships: variation with socioeconomic deprivation in the white population of England. Clin Transplant 27:E327–E331CrossRefPubMedGoogle Scholar
  34. 34.
    Bendorf A, Pussell BA, Kelly PJ, Kerridge IH (2013) Socioeconomic, demographic and policy comparisons of living and deceased kidney transplantation rates across 53 countries. Nephrology 18:633–640CrossRefPubMedGoogle Scholar
  35. 35.
    Furth SL, Garg PP, Neu AM, Hwang W, Fivush BA, Powe NR (2000) Racial differences in access to the kidney transplant waiting list for children and adolescents with end-stage renal disease. Pediatrics 106:756–761CrossRefPubMedGoogle Scholar
  36. 36.
    Hall YN, Choi AI, Xu P, O’Hare AM, Chertow GM (2011) Racial ethnic differences in rates and determinants of deceased donor kidney transplantation. J Am Soc Nephrol 22:743–751CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Joshi S, Gaynor JJ, Bayers S, Guerra G, Eldefrawy A, Chediak Z, Companioni L, Sageshima J, Chen L, Kupin W, Roth D, Mattiazzi A, Burke GW 3rd, Ciancio G (2013) Disparities among blacks, hispanics, and whites in time from starting dialysis to kidney transplant waitlisting. Transplantation 95:309–318CrossRefPubMedGoogle Scholar
  38. 38.
    Kurella-Tamura M, Goldstein BA, Hall YN, Mitani AA, Winkelmayer WC (2014) State medicaid coverage, ESRD incidence, and access to care. J Am Soc Nephrol 25:1321–1329CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Nee R, Jindal RM, Little D, Ramsey-Goldman R, Agodoa L, Hurst FP, Abbott KC (2013) Racial differences and income disparities are associated with poor outcomes in kidney transplant recipients with lupus nephritis. Transplantation 95:1471–1478CrossRefPubMedGoogle Scholar
  40. 40.
    Jaffa MA, Woolson RF, Lipsitz SR, Baliga PK, Lopes-Virella M, Lackland DT (2010) Analyses of renal outcome following transplantation adjusting for informative right censoring and demographic factors: a longitudinal study. Ren Fail 32:691–698CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Chakkera HA, O’Hare AM, Johansen KL, Hynes D, Stroupe K, Colin PM, Chertow GM (2005) Influence of race on kidney transplant outcomes within and outside the Department of Veterans Affairs. J Am Soc Nephrol 16:269–277CrossRefPubMedGoogle Scholar
  42. 42.
    Stephens MR, Evans M, Ilham MA, Marsden A, Asderakis A (2010) The influence of socioeconomic deprivation on outcomes following renal transplantation in the United kingdom. Am J Transplant 10:1605–1612CrossRefPubMedGoogle Scholar
  43. 43.
    Lentine KL, Schnitzler MA, Xiao H, Saab G, Salvalaggio PR, Axelrod D, Davis CL, Abbott KC, Brennan DC (2010) Racial variation in medical outcomes among living kidney donors. N Engl J Med 363:724–732CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Tanriover B, Stone PW, Mohan S, Cohen DJ, Gaston RS (2013) Future of medicare immunosuppressive drug coverage for kidney transplant recipients in the United States. Clin J Am Soc Nephrol 8:1258–1266CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Patzer RE, Mohan S, Kutner N, McClellan WM, Amaral S (2015) Racial and ethnic disparities in pediatric renal allograft survival in the United States. Kidney Int 87:584–592CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Ragupathy R, Aaltonen K, Tordoff J, Norris P, Reith D (2012) A 3-dimensional view of access to licensed and subsidized medicines under single-payer systems in the US, the UK, Australia and New Zealand. Pharmacoeconomics 30:1051–1065CrossRefPubMedGoogle Scholar
  47. 47.
    Glover J, Rosman D, Tennant S (2004) Unpacking analyses relying on area-based data: are the assumptions supportable? Int J Health Geogr 3:30CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© IPNA 2015

Authors and Affiliations

  • Anna Francis
    • 1
  • Madeleine Didsbury
    • 1
  • Wai H. Lim
    • 2
  • Siah Kim
    • 1
  • Sarah White
    • 1
  • Jonathan C. Craig
    • 1
  • Germaine Wong
    • 1
    Email author
  1. 1.Sydney School of Public HealthUniversity of SydneySydneyAustralia
  2. 2.Sir Charles Gairdner HospitalNedlandsAustralia

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