Posterior urethral valves: Examining the relationship of socioeconomic factors in disease presentation and progression.

Introduction: A significant portion of posterior urethral valve patients continue to progress to end stage renal disease despite improvements in medical care. Socioeconomic status has been connected to various healthcare outcomes but has not been evaluated in relation to longitudinal outcomes of posterior urethral valves.

Objective: To evaluate the effect of socioeconomic status on the progression to renal failure among patients with posterior urethral valves.

Study Design: A retrospective review of posterior urethral valve patients receiving urologic care at a tertiary care center was carried out from 1998 to 2018. Measures of socioeconomic status and community disadvantage (Area Deprivation Index [ADI]) were collected for each patient and correlated with renal outcomes. The primary outcome was renal transplant with secondary outcomes including chronic kidney disease, dialysis, and early valve diagnosis.

Results: A total of 145 patients were identified who underwent management for posterior urethral valves during the study period. The median ADI was 74th percentile with 41 patients at severe disadvantage with an ADI in the 85th percentile or higher. 71 % of the population had private insurance. Disadvantaged patients had a higher rate of diagnosis prior to 6 months of age (75 % vs 54 %, p = 0.03). Otherwise, they had similar presentations and urologic care. Dialysis was significantly more common in the disadvantaged population (24 % vs 10 %, p = 0.02). The only predictor of renal transplantation on multivariable analysis was serum Cr greater than 1 within 1 year of valve ablation (OR 92.70, p < 0.001). Outcomes did not vary with insurance status.

Discussion: An early diagnosis of posterior urethral valves in the disadvantaged population as well as higher rates of dialysis suggest more severe disease in this group. These findings may be influenced by differences in the care these children receive both pre-natally and in the peri-transplant period. Limitations of this study include its retrospective nature, sample size and missing information that would more accurately inform these hypotheses.

Conclusions: Severe community disadvantage was associated with higher rates of dialysis and early diagnosis of posterior urethral valves suggesting more severe disease at birth in this population. Consideration of socioeconomic status may suggest differences in prenatal care and draw attention to patients with severe disease that would benefit from further support.