Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom.
United Kingdom Renal Registry, The Renal Association, Bristol, United Kingdom.
Clin J Am Soc Nephrol. 2021 Feb 8;16(2):194-203. doi: 10.2215/CJN.11020720. Epub 2021 Jan 19.
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 specified covariates.
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.
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.
对于符合肾移植条件的肾衰竭儿童，提倡进行预防性肾移植，这是最佳实践；但由于就诊较晚，这种方法受到限制。我们旨在确定社会经济贫困程度和/或地理位置（与中心的距离以及农村/城市居住情况）是否与就诊延迟有关，以及这些因素在多大程度上可以解释获得预防性移植的差异。
设计、地点、参与者和测量：本研究使用了前瞻性收集的英国肾脏登记处和国家卫生服务血液与移植数据，时间为 1996 年 1 月 1 日至 2016 年 12 月 31 日。我们纳入了开始肾脏替代治疗时年龄＞3 个月至≤16 岁的儿童。多变量逻辑回归模型用于确定上述暴露因素与我们的结局之间的关系：就诊延迟（定义为首次肾病检查后 90 天内开始肾脏替代治疗）和预防性移植，并指定了特定的协变量。
在 2160 名儿童（41%为女性）中进行了分析，他们在首次肾病检查时的中位年龄为 3.8 岁（四分位间距，0.2-9.9 岁）。排除缺失数据后，有 478 名（24%）为就诊延迟者；565 名（26%）接受了预防性移植，其中无就诊延迟者。在未校正和校正分析中，距离或社会经济贫困程度与就诊延迟均无关联。排除就诊延迟者后，地区富裕程度越高，接受预防性移植的可能性越高（优势比，每五分位增加 1 个单位，1.20；95%置信区间，1.10 至 1.31），南亚裔（优势比，0.52；95%置信区间，0.36 至 0.76）或黑人（优势比，0.31；95%置信区间，0.12 至 0.80）儿童接受移植的可能性较低。在粗分析中，距中心的距离与预防性移植相关；但在多变量模型中，这种关系减弱（优势比，每 10 公里增加 1.02；95%置信区间，0.99 至 1.05）。
在英国，社会经济贫困程度或地理位置与儿童就诊延迟无关。地理位置与预防性移植无独立关联；但来自较富裕地区的儿童更有可能接受预防性移植。
