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Differences in dialysis modality choice between immigrant and native populations in Barcelona, Spain
María Dolores Arenas-Jiménez1, Jose Luis Fernandez-Martin2, Isabel Galcerán Herrera3
1Fundación Renal, Madrid, Spain.
Insights
Most immigrants in Barcelona opt for center-based hemodialysis (HD) over peritoneal dialysis (PD), despite being healthier. This highlights a need to address socioeconomic and cultural factors in renal replacement therapy (RRT) choices for immigrant populations.
Area of Science:
- Nephrology
- Public Health
- Sociology
Background:
- Limited research exists on renal replacement therapy (RRT) modality choices among immigrant populations in Spain.
- Advanced chronic kidney disease (ACKD) management requires understanding patient preferences and socioeconomic factors influencing treatment decisions.
Purpose of the Study:
- To analyze the impact of migration on RRT decision-making in patients with ACKD in Barcelona.
- To compare RRT modality choices between immigrant and Spanish patients.
- To identify socioeconomic and cultural needs influencing these choices.
Main Methods:
- Retrospective analysis of 673 patients (2009-2020) with ACKD (stage 4-5) from an ACKD clinic.
- Comparison of RRT modality selection (hemodialysis vs. peritoneal dialysis) between immigrant and Spanish patient groups.
- Assessment of demographic, clinical, and social factors, including language barriers and employment status.
Main Results:
- Immigrant patients (16.8%) more frequently chose center-based hemodialysis (79.5%) compared to peritoneal dialysis (12.5%) than Spanish patients (55.5% HD, 25% PD).
- Immigrants started RRT with lower eGFR and shorter follow-up. Language barriers correlated with center-HD choice; employment favored PD.
- Spanish patients initially showed a higher mortality risk, which disappeared after age adjustment. Nearly 60% of individuals lacked social service linkage.
Conclusions:
- Immigrant populations in Barcelona disproportionately select center-based hemodialysis, irrespective of their younger age and better functional status.
- Addressing socioeconomic and cultural determinants of health is crucial for equitable RRT decision-making.
- Healthcare providers must consider cultural nuances and social support systems to reduce health inequities in ACKD management.
Abstract:
Few studies have analyzed the freedom to choose their renal replacement treatment (RRT) modality in Spain. In a total of 673 patients with ACKD (stage 4 and 5) seen at the outpatient ACKD clinic of Hospital del Mar, Barcelona, Catalonia (Spain) from 2009 to 2020, we retrospectively compared immigrant and Spanish patients in order to analyze the impact of migration on RRT decision-making and its subsequent evolution in advanced CKD (ACKD) consultation and identifies the social and economic needs of this population. One hundred thirteen (16.8%) patients were immigrants and 560 were Spanish (83.2%). Migrants more frequently chose HD at a center (79.5%) than PD (12.5%) compared to Spaniards (HD 55.5% and 25% PD) despite being younger and more independent in basic and instrumental activities of daily living. Immigrant patients started RRT with lower eGFR (8.1 vs. 9.1 mL/min/1.73 m3) and after a shorter follow-up time in the ACKD consultation than the Spaniards (22 vs. 32 months). The language barrier was associated with a greater choice of center-based HD and active employment status favored the choice of PD. Spanish patients had a significantly higher relative risk of mortality compared with immigrant patients (HR = 3.27[95%CI:1.17-9.17], p = 0.024). However, after adjustment by age, this increased relative risk of mortality disappeared (HR 1.99[0.69-5.76], p = 0.206). Almost 60% individuals were not linked to social services. In conclusion, most immigrants in Barcelona choose center-HD versus DP despite being younger and more independent in basic and instrumental activities of daily living and being in a better condition than Spanish patients. Considering the socioeconomic and cultural needs of the immigrant population we serve is necessary to effectively reduce health inequities. Keywords: advanced chronic kidney disease, socioeconomic status, demographic factors, shared decision making, renal replacement therapy, peritoneal dialysis, conservative care, hemodialysis, renal transplantation, language barrier, social determinants of health, immigration, social determinants of health.
