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The following is a summary of “Posterior Urethral Valves: Examining the Relationship of Socioeconomic Factors in Disease Presentation and Progression,” published in the January 2025 issue of Pediatrics by Staniorski et al.

Despite advancements in medical care, a substantial proportion of patients with posterior urethral valves progress to end-stage renal disease. Socioeconomic status is a known determinant of various healthcare outcomes but has not been extensively examined in the longitudinal progression of posterior urethral valve-related renal failure. This study aimed to evaluate the impact of Socioeconomic status, as measured by the Area Deprivation Index (ADI), on renal outcomes in patients with posterior urethral valves.

A retrospective review was conducted on 145 patients who received urologic care for posterior urethral valves at a tertiary care center from 1998 to 2018. Socioeconomic data, including ADI and insurance status, were collected and analyzed against renal outcomes such as chronic kidney disease, dialysis, and renal transplantation. The cohort had a median ADI at the 74th percentile, with 41 patients categorized as severely disadvantaged (ADI ≥85th percentile). Most patients (71%) had private insurance.

Severely disadvantaged patients were more likely to receive an early diagnosis of posterior urethral valves, with 75% diagnosed before six months of age compared to 54% in less disadvantaged groups (p=0.03). Dialysis was significantly more common in the disadvantaged group (24% vs. 10%, p=0.02), reflecting more severe disease. However, urologic care delivery and other outcomes, including renal transplantation, did not significantly vary by Socioeconomic status or insurance status. Multivariable analysis identified serum creatinine greater than 1 mg/dL within one year of valve ablation as the sole significant predictor of renal transplantation (OR 92.70, p<0.001).

These findings suggest that patients from severely disadvantaged communities present with more severe disease at birth, as evidenced by earlier diagnosis and higher rates of dialysis. Differences in prenatal care and postnatal management may contribute to these disparities. While this study is limited by its retrospective design, sample size, and incomplete data, it underscores the importance of considering Socioeconomic status as a factor in posterior urethral valves management. Enhanced prenatal screening and targeted postnatal support for disadvantaged populations may improve outcomes and mitigate the progression of renal disease in these vulnerable groups. Future research should further explore Socioeconomic status-driven disparities to inform interventions and optimize care.

Source: sciencedirect.com/science/article/abs/pii/S1477513125000130