Care processes and outcomes of deprivation across the clinical course of kidney disease: Findings from a high-income country with universal healthcare

Simon Sawhney* (Corresponding Author), Thomas Blakeman, Dimitra Blana, Dwayne Boyers, Nick Fluck, Mintu Nath, Shona Methven, Magdalena Rzewuska, Corri Black

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


No single study contrasts the extent and consequences of inequity of kidney care across the clinical course of kidney disease.
This population study of Grampian (UK) followed incident presentations of AKI, and incident eGFR thresholds of < 60, <45 and < 30 in separate cohorts (2011–2021). The key exposure was area-level deprivation (lowest quintile of the Scottish Index of Multiple Deprivation). Outcomes were care processes (monitoring, prescribing, appointments, unscheduled care); long-term mortality; and kidney failure. Modelling involved multivariable logistic regression, negative binomial regression, and cause specific Cox models with/without adjustment of comorbidities.
There were 41 313, 51 190, 32 171, and 17 781 new presentations of AKI, and eGFR thresholds < 60, <45 and < 30. 6.1–7.8% were from deprived areas, and (vs all others) presented on average five years younger, with more diabetes, pulmonary and liver disease. Those from deprived areas were more likely to present initially in hospital, less likely to receive community monitoring, less likely to attend appointments, and more likely to have an unplanned emergency department or hospital admission episode. Deprivation had greatest association with long-term kidney failure at the eGFR < 60 threshold (adjusted HR 1.48, 1.17–1.87), and this association attenuated with advancing disease severity (HR 1.09, 0.93–1.28 at eGFR < 30); with a similar pattern for mortality. Across all analyses the most detrimental associations of deprivation were at an eGFR < 60 threshold, AKI, males, and those aged < 65 years.
Even in a high-income country with universal healthcare, serious and consistent inequities of kidney care exist. The poorer care and outcomes with area-level deprivation were greater earlier in the disease course.
Original languageEnglish
Pages (from-to)1170-1182
Number of pages13
JournalNephrology Dialysis Transplantation
Issue number5
Early online date23 Jul 2022
Publication statusPublished - 4 May 2023

Bibliographical note

We are grateful to Audrey Hughes, on behalf of Grampian Kidney Patient Association, for her input into the design and interpretation of the analysis. We acknowledge the support of the Grampian Data Safe Haven (DaSH) facility within the Aberdeen Centre for Health Data Science and the associated financial support of the University of Aberdeen, and NHS Research Scotland (through NHS Grampian investment in DaSH). For more information, visit the DaSH website:

Dr Sawhney is supported by a Starter Grant for Clinical Lecturers from the Academy of Medical Sciences, Wellcome Trust, Medical Research Council, British Heart Foundation, Arthritis Research UK, the Royal College of Physicians and Diabetes UK [SGL020\1076]. Dr Black is supported by Health Data Research UK, which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation and the Wellcome Trust.

Data Availability Statement

Supplementary data:
Supplementary data are available at ndt online.


  • AKI
  • CKD
  • epidemiology
  • care processes
  • Prognosis
  • health inequalities


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