In children whose kidneys have failed, renal replacement therapy (RRT) is life-saving, either as dialysis or a kidney transplant. Kidney transplantation is the first choice of RRT for children. It offers the best chance for near-normal growth and development. In an ideal situation, a child whose kidneys are failing would receive a transplant before their kidneys stop working altogether: this is called a pre-emptive transplant (PET). Currently, about one in four UK children starting RRT receive a PET. There are many possible reasons why PET numbers are not higher. Being very young (less than 2 years) and finding out about a kidney problem at a late stage of the disease means you are less likely to get a PET (late presentation). Studies have found that females and non-white patients are also less likely to benefit, although reasons are unclear. In the UK, it is not known whether being deprived or living far away from a kidney centre affects 1) how early/late a child's kidney problem is identified or 2) their chances of receiving a PET. We aim to explore these issues using information from the UK Renal Registry.

Kidney transplantation offers children the best opportunity for normal growth and development. Pre-emptive transplantation (PET) has been associated with improved patient survival, fewer rejection episodes and less delayed graft function. It is also the most cost-effective modality. Increasing the number of children who receive pre-emptive kidney transplantation will therefore not only be beneficial to patients and families, but to the NHS. To do this, inequalities relating to transplant access, in the context of the UK National Health Service, must be understood. This study will explore whether two important non-clinical variables: deprivation (as measured by socioeconomic status, SES) and geographical distance are associated with late presentation and/or access to pre-emptive transplantation. The outcomes of this study will support the design of future strategies aimed at improving detection of chronic kidney disease and access to transplant for UK children.