Differences in dialysis modality choice between immigrant and native populations in Barcelona, Spain

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.