Is social deprivation associated with the peritoneal dialysis outcomes? A cohort study with REIN registry data

Background:Social deprivation is associated with lower peritoneal dialysis (PD) uptake. This study was carried out to evaluate the role of social deprivation on the outcome of PD.Methods:This was a retrospective study of data extracted from the Renal Epidemiology and Information Network registry for patients older than 18 years who started PD in metropolitan France between 1 January 2017 and 30 June 2018. The end of the observation period was 31 December 2020. The exposure was the European Deprivation Index calculated using the patient’s address. The events of interest were death, transfer to haemodialysis (HD), transplantation and the composite event of death or transfer to HD. A Cox model and Fine and Gray model were used for the analysis.Results:A total of 1581 patients were included, of whom 418 (26.5%) belonged to Quintile 5 of the European Deprivation Index (the most deprived patients). In the Cox model, the most deprived subjects did not have a greater risk of death (cause-specific hazard ratio (cs-HR): 0.76 [95% confidence interval (CI): 0.53–1.10], transfer to HD (cs-HR 1.37 [95% CI: 0.95–1.98]) or the composite event of death or transfer to HD (cs-HR: 1.08 [95% CI: 0.84–1.38]) or a lower risk of kidney transplantation (cs-HR: 0.73 [95% CI: 0.48–1.10]). In the competing risk analysis, the most deprived subjects had a higher risk of transfer to HD (subdistribution hazard ratio (sd-HR): 1.54 [95% CI: 1.08–2.19]) and lower access to kidney transplantation (sd-HR: 0.68 [0.46–0.99]).Conclusion:In PD patients, social deprivation was not associated with death or the composite event of death or transfer to HD. Socially deprived individuals had a greater risk of transfer to HD and lower access to kidney transplantation in the competing risk analysis.