Deprivation and chronic kidney disease-a review of the evidence

The relationship between socioeconomic deprivation and health is inequitable. Chronic kidney disease (CKD) is an archetypal disease of inequality, being more common amongst those living in deprivation. The prevalence of CKD is rising driven by an increase in lifestyle-related conditions. This narrative review describes deprivation and its association with adverse outcomes in adults with non-dialysis-dependent CKD including disease progression, end-stage kidney disease, cardiovascular disease and all-cause mortality. We explore the social determinants of health and individual lifestyle factors to address whether patients with CKD who are socioeconomically deprived have poorer outcomes than those of higher socioeconomic status. We describe whether observed differences in outcomes are associated with income, employment, educational attainment, health literacy, access to healthcare, housing, air pollution, cigarette smoking, alcohol use or aerobic exercise. The impact of socioeconomic deprivation in adults with non-dialysis-dependent CKD is complex, multi-faceted and frequently under-explored within the literature. There is evidence that patients with CKD who are socioeconomically deprived have faster disease progression, higher risk of cardiovascular disease and premature mortality. This appears to be the result of both socioeconomic and individual lifestyle factors. However, there is a paucity of studies and methodological limitations. Extrapolation of findings to different societies and healthcare systems is challenging, however, the disproportionate effect of deprivation in patients with CKD necessitates a call to action. Further empirical study is warranted to establish the true cost of deprivation in CKD to patients and societies. Lay Summary People who live in deprivation are more likely to suffer from chronic illness including chronic kidney disease (CKD). Deprivation takes into account 'socioeconomic' factors like income and adequacy of housing including surrounding air pollution. These associate with lifestyle factors: someone on low income may be unable to afford nutritious food or fares to access healthcare. CKD is common and a leading cause of death because it increases both the risk of kidney failure, and illness and death from heart disease. We reviewed published studies to see if patients with CKD have worse outcomes as a result of deprivation. We found that in people exposed to greater levels of deprivation, kidney failure and heart disease are more common. This seems to be the result of a combination of socioeconomic and lifestyle factors. There are, however, relatively few studies and there are many factors that limit the generalizability of the results. Deprivation disproportionately affects CKD patients: this inequality must be a healthcare priority.