Equity of renal replacement therapy utilization: a prospective population-based study

Area of Science:

• Nephrology
• Public Health
• Epidemiology

Background:

• End-stage renal disease (ESRD) necessitates renal replacement therapy (RRT).
• Assessing RRT utilization equity across demographics is crucial for healthcare planning.
• Scotland's RRT program requires ongoing evaluation for incidence and access.

Purpose of the Study:

• To determine the incidence and characteristics of patients initiating RRT in Scotland.
• To evaluate the equity of RRT utilization concerning age, domicile, and socioeconomic status.
• To compare RRT rates against national recommendations and identify demographic disparities.

Main Methods:

• A 1-year prospective survey of all patients starting RRT in Scotland.
• Data collection on patient demographics, ESRD causes, and RRT initiation rates.
• Analysis of RRT utilization across different health boards and socioeconomic groups.

Main Results:

• 104 patients per million population (533 total) started RRT; diabetes was the most common cause (16%).
• Patients over 75 were under-represented, despite RRT need increasing with age.
• RRT utilization exceeded minimum recommendations, with variations between health boards; no evidence of social deprivation influencing acceptance.

Conclusions:

• Scotland's RRT utilization meets recommended rates, but older adults (over 75) are under-represented.
• While socioeconomic factors did not appear to influence RRT acceptance, the complex relationship between ESRD and deprivation warrants further study.
• Increasing RRT demand is projected due to an aging population, necessitating resource planning.