The Impact of Household Income on Kidney Care

I was greatly interested in the findings of a recent study published in this issue of CJASN on socioeconomic status and kidney disease in British Columbia (1). I did in-center hemodialysis for 3 years and saw people from a variety of socioeconomic backgrounds there. I often thought how lucky I am to have the resources I do.

This study researched the statistical correlation between socioeconomic status and the prevalence of four types of kidney diseases: ANCA GN, lupus nephritis, FSGS, and membranous nephropathy. All of these diseases affect the immune response and in some way cause inflammation. The two diseases that showed a significant level of difference with socioeconomic status were ANCA and lupus. The study also discloses that it was not designed to exhaustively explore the reasons for these differences and had some statistical limitations in some populations. It also did not attempt to correlate the average progression or state of these diseases to income.

As a patient myself, it is easy to be discouraged by this type of study. It brings little relief to those with limited financial resources and might actually cause despair for patients reading the study. Perhaps studies like these may help some patients to adjust psychologically to what might be in their future. I have IgA nephropathy. I know my prognosis includes the possibility of reoccurrence even with my second transplant. It has taken me time to adjust to this prognosis, but my life is more focused as a result.

With IgA nephropathy, I now understand how important it is to manage stress and inflammation. I was unable to work for extended periods, which is enough to increase one’s stress level, aside from also suffering from kidney disease. During times of financial and emotional stress, it was not easy to focus on my own diet and hygiene. I would wake up and immediately look at my online banking statement. Would I eat breakfast, brush my teeth, and take my medication in a timely fashion? On a good day, I would.

Education and emotional support are two factors that make a significant difference in patient outcomes. This study did not have access to educational levels within the income data. However, I have an advanced degree and I had five decades of life experience before my kidneys failed; I could learn what I needed to know. I also had a family, church, and friends to lean on for emotional support. It would be interesting to correlate education and support into the research, because they are important factors in managing stress.

The demographics in British Columbia are different from many regions in the United States due to a significant Asian population. There are far fewer Latino and black patients and these ethnicities have a higher incidence of ESKD, as well as different cultural patterns. As an example, the Asian population typically eats fewer beans and more fish. So, it is hard to directly compare British Columbia to the United States. Perhaps research of a more diverse patient population would give more insights into the United States nephrology community.

The article also mentioned research on the interaction between methylation, kidney function, and kidney regeneration. My oldest son has methylation deficiencies that are shown in genetic markings. My wife used this knowledge to discover and address the related issues he had. I also did genetic testing that showed a similar methylation issue and my predisposition to kidney disease. I began taking a vitamin B12 supplement that is more bioavailable than the usual over-the-counter B-complex vitamins and have noticed a difference. Although anecdotal evidence is insufficient for changing the standard of care, it gives me hope that if we investigate (2), better care is possible in many areas.

Finally, the article also cites a study that indicates children “raised in unfavorable socioeconomic circumstances” show a greater prevalence of proinflammatory signaling. I agree with the summary of that article, because it appears congruent with research done by Dr. Nadine Burke Harris (3). She is the Surgeon General of California, a pediatrician, and the most well known proponent of the adverse-childhood-experiences model to describe the lasting effects of pediatric stress. It would come as no surprise to me that such stress affects endocrine organs including the kidney.

Research studies typically have me asking, “What if…?” This article was no different.

Disclosures

Mr. Weed has nothing to disclose.