Background: Chronic kidney disease (CKD) prevalence and complications are known to be associated with deprivation, but there is limited understanding of the underlying reasons for inequalities. Aims: To evaluate the association of both individual and area level socioeconomic status (SES) with heavy proteinuria at presentation, progression of CKD, end-stage renal disease (ESRD) and death. Methods: A retrospective study of 918 CKD patients using integral multivariate logistic regression to adjust for known clinical and demographic explanatory variables. Results: During 3 years of median follow-up, 34% of the study population had progression of their CKD and of these, 32% experienced rapid progression. 23% presented with heavy proteinuria (urine protein:creatinine ratio ≥300 mg/mmol), 4% developed ESRD requiring renal replacement therapy and 10% died. Area level deprivation was independently associated with heavy proteinuria, progression and rapid progression of CKD. People living in the most deprived areas were more likely to develop ESRD. Unskilled professionals were more likely to experience a higher mortality rate. Conclusion: Area level SES is inversely associated with both heavy proteinuria on presentation and progression as well as rapid progression of CKD. In contrast, individual level SES, unskilled professionals found to have a marginally significant association with increased risk of mortality. People living in more deprived areas presenting with CKD are likely to be at increased risk of poor outcomes and may need more active management and earlier referral.

Schoolwerth AC, Engelgau MM, Hostetter TH, Rufo KH, Chianchiano D, McClellan WM, Warnock DG, Vinicor F: Chronic kidney disease: a public health problem that needs a public health action plan. Prev Chronic Dis 2006;3:A576.
Meguid El Nahas A, Bello AK: Chronic kidney disease: the global challenge. Lancet 2005;365:331–340.
Levey AS, Atkins R, Coresh J, Cohen EP, Collins AJ, Eckardt KU, Nahas ME, Jaber BL, Jadoul M, Levin A, Powe NR, Rossert J, Wheeler DC, Lameire N, Eknoyan G: Chronic kidney disease as a global public health problem: approaches and initiatives – a position statement from Kidney Disease Improving Global Outcomes. Kidney Int 2007;72:247–259.
McClellan WM, Flanders WD: Risk factors for progressive chronic kidney disease. J Am Soc Nephrol 2003;14:S65–S70.
Bleyer AJ, Shemanski LR, Burke GL, Hansen KJ, Appel RG: Tobacco, hypertension, and vascular disease: risk factors for renal functional decline in an older population. Kidney Int 2000;57:2072–2079.
Byrne C, Nedelman J, Luke RG: Race, socioeconomic status, and the development of end-stage renal disease. Am J Kidney Dis 1994;23:16–22.
Martins D, Tareen N, Zadshir A, Pan D, Vargas R, Nissenson A, Norris K: The association of poverty with the prevalence of albuminuria: data from the Third National Health and Nutrition Examination Survey (NHANES III). Am J Kidney Dis 2006;47:965–971.
Shoham DA, Vupputuri S, Diez Roux AV, Kaufman JS, Coresh J, Kshirsagar AV, Zeng D, Heiss G: Kidney disease in life-course socioeconomic context: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis 2007;49:217–226.
Merkin SS, Coresh J, Roux AV, Taylor HA, Powe NR: Area socioeconomic status and progressive CKD: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis 2005;46:203–213.
Merkin SS, Roux AV, Coresh J, Fried LF, Jackson SA, Powe NR: Individual and neighborhood socioeconomic status and progressive chronic kidney disease in an elderly population: The Cardiovascular Health Study. Soc Sci Med 2007;65:809–821.
National Cancer Institute. Harms of Smoking and Health Benefits of Quitting: Reviewed Report 2010 (
National Institute of Health: Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults – The Evidence Report from National Institutes of Health. Obes Res 1998;6(suppl 2):S51–S209.
Index of Multiple Deprivation 2007: Measure of Deprivation at Small Area Level. Communities and Local Government, UK (
Noble M, McLennan D, Wilkinson K, Whitworth A, Exley S, Barnes H: The English Indices of Deprivation 2004 – Summary (
Standard Occupational Classification 2010 The Standard Occupational Classification (SOC) is a common classification of occupational information for the United Kingdom.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA 2003;289:2560–2572.
K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39:S1–266.
Perneger TV, Whelton PK, Klag MJ: Race and end-stage renal disease. Socioeconomic status and access to health care as mediating factors. Arch Intern Med 1995;155:1201–1208.
Byrne C, Nedelman J, Luke RG: Race, socioeconomic status, and the development of end-stage renal disease. Am J Kidney Dis 1994;23:16–22.
Young EW, Mauger EA, Jiang KH, Port FK, Wolfe, RA: Socioeconomic status and end-stage renal disease in the United States. Kidney Int 1994;45:907–911.
Ward MM: Access to care and the incidence of end-stage renal disease due to diabetes. Diabetes Care 2009;32:1032–1036.
Wolf G, Busch M, Muller N, Muller UA: Association between socioeconomic status and renal function in a population of German patients with diabetic nephropathy treated at a tertiary center. Nephrol Dial Transplant 2011 (E-pub ahead of print).
Haroun MK, Jaar BG, Hoffman SC, Comstock GW, Klag MJ, Coresh J: Risk factors for chronic kidney disease: a prospective study of 23,534 men and women in Washington County, Maryland. J Am Soc Nephrol 2003;14:2934–2941.
Franchini I, Alinovi R, Bergamaschi E, Mutti A: Contribution of studies on renal effects of heavy metals and selected organic compounds to our understanding of the progression of chronic nephropathies towards renal failure. Acta Biomed 2005;76(suppl 2):58–67.
Barbier O, Jacquillet G, Tauc M, Cougnon M, Poujeol P: Effect of heavy metals on, and handling by, the kidney. Nephron Physiol 2005;99:105–110.
Sabolic I: Common mechanisms in nephropathy induced by toxic metals. Nephron Physiol 2006;104:107–114.
Wedeen RP: Occupational and environmental renal disease. Semin Nephrol 1997;17:46–53.
Gelber RP, Kurth T, Kausz AT, Manson JE, Buring JE, Levey AS, Gaziano JM: Association between body mass index and CKD in apparently healthy men. Am J Kidney Dis 2005;46:871–880.
Smith GD, Hart C, Watt G, Hole D, Hawthorne V: Individual social class, area-based deprivation, cardiovascular disease risk factors, and mortality: the Renfrew and Paisley Study. J Epidemiol Community Health 1998;52:399–405.
Shohaimi S, Luben R, Wareham N, Day N, Bingham S, Welch A, Oakes S, Khaw KT: Residential area deprivation predicts smoking habit independently of individual educational level and occupational social class. A cross-sectional study in the Norfolk cohort of the European Investigation into Cancer (EPIC-Norfolk). J Epidemiol Community Health 2003;57:270–276.
Kleinschmidt I, Hills M, Elliott P: Smoking behaviour can be predicted by neighbourhood deprivation measures. J Epidemiol Community Health 1995;49(suppl 2):S72–S77.
Townsend J, Roderick P, Cooper J: Cigarette smoking by socioeconomic group, sex, and age: effects of price, income, and health publicity. BMJ 1994;309:923–927.
Osler M, Holstein B, Avlund K, Damsgaard MT, Rasmussen NK: Socioeconomic position and smoking behaviour in Danish adults. Scand J Public Health 2001;29:32–39.
Hunsicker LG, Adler S, Caggiula A, England BK, Greene T, Kusek JW, Rogers NL, Teschan PE: Predictors of the progression of renal disease in the Modification of Diet in Renal Disease Study. Kidney Int 1997;51:1908–1919.
Lash JP, Go AS, Appel LJ, He J, Ojo A, Rahman M, Townsend RR, Xie D, Cifelli D, Cohan J, Fink JC, Fischer MJ, Gadegbeku C, Hamm LL, Kusek JW, Landis JR, Narva A, Robinson N, Teal V, Feldman HI: Chronic Renal Insufficiency Cohort (CRIC) Study: baseline characteristics and associations with kidney function. Clin J Am Soc Nephrol 2009;4:1302–1311.
Ward MM: Access to care and the incidence of end-stage renal disease due to diabetes. Diabetes Care 2009;32:1032–1036.
Maheswaran R, Payne N, Meechan D, Burden RP, Fryers PR, Wight J, Hutchinson A: Socioeconomic deprivation, travel distance, and renal replacement therapy in the Trent Region, United Kingdom, 2000: an ecological study. J Epidemiol Community Health 2003;57:523–524.
Jafar TH, Stark PC, Schmid CH, Landa M, Maschio G, de Jong PE, de Zeeuw D, Shahinfar S, Toto R, Levey AS: Progression of chronic kidney disease: the role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition: a patient-level meta-analysis. Ann Intern Med 2003;139:244–252.
Keane WF, Brenner BM, de Zeeuw D, Grunfeld JP, McGill J, Mitch WE, Ribeiro AB, Shahinfar S, Simpson RL, Snapinn SM, Toto R: The risk of developing end-stage renal disease in patients with type 2 diabetes and nephropathy: the RENAAL study. Kidney Int 2003;63:1499–1507.
Ruggenenti P, Perna A, Mosconi L, Pisoni R, Remuzzi G: Urinary protein excretion rate is the best independent predictor of ESRF in non-diabetic proteinuric chronic nephropathies. ‘Gruppo Italiano di Studi Epidemiologici in Nefrologia’ (GISEN). Kidney Int 1998;53:1209–1216.
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