Social determinants of health and the transition from advanced chronic kidney disease to kidney failure.

BACKGROUND: The transition from CKD to kidney failure is a vulnerable time for patients, with suboptimal transitions associated with increased morbidity and mortality. Whether social determinants of health are associated with suboptimal transitions is not well understood.

METHODS: This retrospective cohort study included 1,070 patients with advanced CKD who were referred to the Ottawa Hospital Multi-Care Kidney Clinic and developed kidney failure (dialysis or kidney transplantation) between 2010-2021. Social determinant information including education level, employment status, and marital status was collected under routine clinic protocol. Outcomes surrounding suboptimal transition included inpatient (vs. outpatient) dialysis starts, pre-emptive (vs. delayed) access creation, and pre-emptive kidney transplantation. We examined the association between social determinants of health and suboptimal transition outcomes using multivariable logistic regression.

RESULTS: The mean age and eGFR were 63 years and 18 mL/min/1.73m2. Not having a high school degree was associated with higher odds for an inpatient dialysis start compared to a college degree (OR 1.71 [95%CI 1.09-2.69]). Unemployment was associated with higher odds for an inpatient dialysis start (OR 1.85 [95%CI 1.18-2.92]), lower odds for pre-emptive access creation (OR 0.53 [95%CI 0.34-0.82]), and lower odds for pre-emptive kidney transplantation (OR 0.48 [95%CI 0.24-0.96]) compared to active employment. Being single was associated with higher odds for an inpatient dialysis start (OR 1.44 [95%CI 1.07-1.93]) and lower odds for pre-emptive access creation (OR 0.67 [95%CI 0.50-0.89]) compared to being married.

CONCLUSIONS: Social determinants of health including education, employment, and marital status are associated with suboptimal transitions from CKD to kidney failure.