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Abstract
Objectives
We assessed the direct and indirect effect of social deprivation mediated by modifiable
markers of nephrological follow-up on registration on the renal transplantation waiting-list.
Study design and settings
From the Renal Epidemiology and Information Network, we included French incident dialysis
patients eligible for a registration evaluation between January 2017 and June 2018.
Mediation analyses were conducted to assess effects of social deprivation estimated
by quintile 5 (Q5) of the European Deprivation Index on registration defined as wait-listing
at dialysis start or within the first 6 months.
Results
Among the 11655 included patients, 2410 were registered. Q5 had a direct effect on
registration (OR 0.82 [0.80-0.84]) and an indirect effect mediated by emergency start
dialysis (OR 0.97 [0.97-0.98]), hemoglobin < 11 g/dL and/or lack of EPO (OR 0.96 [0.96-0.96])
and albumin < 30 g/L (OR 0.98 [0.98-0.99]).
Conclusion
Social deprivation was directly associated with a lower registration on the renal
transplantation waiting-list but its effect was also mediated by markers of nephrological
care, suggesting that improving the follow-up of the most deprived patients should
help to reduce disparities in access to transplantation.
Graphical abstract
Graphical Abstract
Key words
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Article info
Publication history
Accepted:
March 6,
2023
Received in revised form:
February 22,
2023
Received:
August 10,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
