Social determinants of health influencing the choice of dialysis modality in advanced chronic kidney disease: Need of an interdisciplinary approach
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- dc.contributor.author Arenas, María Dolores
- dc.contributor.author Fernández-Chamarro, Marisol
- dc.contributor.author Pedreira Robles, Guillermo
- dc.contributor.author Collado Nieto, Silvia
- dc.contributor.author Farrera, Julia
- dc.contributor.author Galceran Herrera, Isabel
- dc.contributor.author Barbosa, Francesc
- dc.contributor.author Cao Baduell, Higinio
- dc.contributor.author Moreno, Alicia
- dc.contributor.author Morro, Laura
- dc.contributor.author Fernández-Martin, Jose Luis
- dc.contributor.author Crespo Barrio, Marta
- dc.contributor.author Pascual Santos, Julio
- dc.date.accessioned 2025-07-08T13:51:21Z
- dc.date.available 2025-07-08T13:51:21Z
- dc.date.issued 2024
- dc.description Article disponible en castellà: http://hdl.handle.net/10230/70868
- dc.description.abstract Introduction: The influence of socioeconomic and cultural barriers in the choice of renal replacement therapy (RRT) techniques in advanced chronic kidney disease (ACKD) has been scarcely explored, which can generate problems of inequity, frequently unnoticed in health care. The aim of this study is to identify the "non-medical" barriers that influence the choice of RRT in an advanced chronic kidney disease (ACKD) consultation in Spain. Material and methods: Retrospective analysis including the total number of patients seen in the ACKD consultation in a tertiary hospital from 2009 to 2020. Inclusion in the ACKD consultation began with an eligibility test and a decision-making process, conducted by a specifically trained nurse. The variables considered for the study were: age, sex, etiology of CKD, level of dependence for basic activities of daily living (Barthel Scale) and instrumental activities of daily living (Lawton and Brody Scale), Spanish versus foreign nationality, socioeconomic level and language barrier. The socioeconomic level was extrapolated according to home and health district by primary care center to which the patients belonged. Results: A total of 673 persons were seen in the ACKD consultation during the study period, of whom 400 (59.4%) opted for hemodialysis (HD), 156 (23.1%) for peritoneal dialysis (PD), 4 (0.5%) for early living donor renal transplantation (LDRT) and 113 (16.7%) chose conservative care (CC). The choice of PD as the chosen RRT technique (vs. HD) was associated with people with a high socioeconomic level (38.7% vs. 22.5%) (p = 0.002), Spanish nationality (91% vs. 77.7%) (p < 0.001), to a lower language barrier (0.6% vs 10.5%) (p < 0.001), and to a higher score on the Barthel scale (97.4 vs 92.9) and on the Lawton and Brody scale (7 vs 6.1) (p < 0.001). Neither age nor sex showed significant differences in the choice of both techniques. Patients who opted for CC were significantly older (81.1 vs 67.7 years; p < 0.001), more dependent (p < 0.001), with a higher proportion of women (49.6% vs 35.2%; p = 0.006) and a higher proportion of Spaniards (94.7% vs 81%, p = 0.001) in relation to the choice of other techniques (PD and HD). Socioeconomic level did not influence the choice of CC. Conclusion: Despite a regulated decision-making process, there are factors such as socioeconomic status, migration, language barrier and dependency of the population that influence the type of RRT chosen. To address these aspects that may cause inequity, an intersectoral and multilevel intervention is required with interdisciplinary teams that include, among others, social workers, to provide a more holistic and person-centered assessment.
- dc.format.mimetype application/pdf
- dc.identifier.citation Arenas MD, Fernández-Chamarro M, Pedreira-Robles G, Collado S, Farrera J, Galceran I, et al. Social determinants of health influencing the choice of dialysis modality in advanced chronic kidney disease: Need of an interdisciplinary approach. Nefrologia (Engl Ed). 2024 Jul-Aug;44(4):560-7. DOI: 10.1016/j.nefroe.2024.07.002
- dc.identifier.doi http://dx.doi.org/10.1016/j.nefroe.2024.07.002
- dc.identifier.issn 2013-2514
- dc.identifier.uri http://hdl.handle.net/10230/70867
- dc.language.iso eng
- dc.publisher Elsevier
- dc.relation.ispartof Nefrologia (Engl Ed). 2024 Jul-Aug;44(4):560-7
- dc.rights © 2023 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
- dc.rights.accessRights info:eu-repo/semantics/openAccess
- dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/4.0/
- dc.subject.keyword Advanced chronic kidney disease
- dc.subject.keyword Socioeconomic status
- dc.subject.keyword Demographic factors
- dc.subject.keyword Shared decision-making
- dc.subject.keyword Renal replacement therapy
- dc.subject.keyword Peritoneal dialysis
- dc.subject.keyword Hemodialysis
- dc.subject.keyword Kidney transplantation
- dc.subject.keyword Language barrier
- dc.subject.keyword Social determinants of health
- dc.title Social determinants of health influencing the choice of dialysis modality in advanced chronic kidney disease: Need of an interdisciplinary approach
- dc.type info:eu-repo/semantics/article
- dc.type.version info:eu-repo/semantics/publishedVersion