Impact of individual socioeconomic deprivation on hemodialysis care and patient behavior: a multicenter French study (Precadia).

BACKGROUND

Socioeconomic deprivation (SED) is increasingly recognized as a key determinant of morbidity and mortality among patients receiving hemodialysis. However, most prior studies have relied on area-level socioeconomic indicators and have been conducted outside of Europe.

OBJECTIVE

To assess whether individual-level socioeconomic status, measured using the EPICES score, influences healthcare quality and patient behaviors in adults undergoing maintenance hemodialysis in northeastern France.

METHODS

This multicenter observational study was conducted across five dialysis units. Adult patients with end-stage renal disease receiving hemodialysis for ≥3 months were enrolled. The EPICES score was used to assess individual SED, and patients were stratified into deprived (P+) and non-deprived (P-) groups based on the median score. Clinical, biochemical, and behavioral variables were compared between groups.

RESULTS

A total of 401 patients were included (mean age 68.5 years; 60% male). The median EPICES score was 33.1 (mean 35.8 ± 18.9). Compared with P - patients, P + patients had a significantly longer dialysis vintage (76.3 vs. 73.9 months,  = .002), higher normalized protein catabolic rate (nPCR; 1.28 vs. 1.06 g/kg/day,  = .007), higher CRP concentrations (14.3 ± 4.1 vs. 9.56 ± 0.8 mg/L,  < .02 ), and greater smoking prevalence (34% vs. 15%,  = .004). No significant differences were observed in albumin and hemoglobin levels, erythropoietin (EPO) dosing, or the frequency of missed dialysis sessions. The CRP × P + interaction on nPCR was significant, suggesting that systemic inflammation could modify the association between deprivation and protein catabolism.

CONCLUSION

Individual-level SED was associated with differences in health behaviors but not in the quality of physician-driven dialysis care. These findings challenge the notion that deprived patients inherently receive lower-quality clinical care and emphasize the need for targeted strategies that address patient-dependent behavioral factors.