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

Abstract

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, p = .002), higher normalized protein catabolic rate (nPCR; 1.28 vs. 1.06 g/kg/day, p = .007), higher CRP concentrations (14.3 ± 4.1 vs. 9.56 ± 0.8 mg/L, p < .02 ), and greater smoking prevalence (34% vs. 15%, p = .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.