Social determinants of health influencing the choice of dialysis modality in advanced chronic kidney disease: Need of an interdisciplinary approach

Arenas, María Dolores; Fernández-Chamarro, Marisol; Pedreira Robles, Guillermo; Collado Nieto, Silvia; Farrera, Julia; Galceran Herrera, Isabel; Barbosa, Francesc; Cao Baduell, Higinio; Moreno, Alicia; Morro, Laura; Fernández-Martin, Jose Luis; Crespo Barrio, Marta; Pascual Santos, Julio

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.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

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