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. 2020 Aug;20(8):2113-2125.
doi: 10.1111/ajt.15791. Epub 2020 Feb 11.

Dialysis facility referral and start of evaluation for kidney transplantation among patients treated with dialysis in the Southeastern United States

Rachel E Patzer  1   2   3 , Laura McPherson  1 , Zhensheng Wang  1 , Laura C Plantinga  2   4 , Sudeshna Paul  5 , Matthew Ellis  6 , Derek A DuBay  7 , Joshua Wolf  8 , Amber Reeves-Daniel  9 , Heather Jones  10 , Carlos Zayas  11 , Laura Mulloy  11 , Stephen O Pastan  3   4
Affiliations

Dialysis facility referral and start of evaluation for kidney transplantation among patients treated with dialysis in the Southeastern United States

Rachel E Patzer et al. Am J Transplant. 2020 Aug.

Abstract

Variability in transplant access exists, but barriers to referral and evaluation are underexplored due to lack of national surveillance data. We examined referral for kidney transplantation evaluation and start of the evaluation among 34 857 incident, adult (18-79 years) end-stage kidney disease patients from 690 dialysis facilities in the United States Renal Data System from January 1, 2012 through August 31, 2016, followed through February 2018 and linked data to referral and evaluation data from nine transplant centers in Georgia, North Carolina, and South Carolina. Multivariable-adjusted competing risk analysis examined each outcome. The median within-facility cumulative percentage of patients referred for kidney transplantation within 1 year of dialysis at the 690 dialysis facilities in Network 6 was 33.7% (interquartile range [IQR]: 25.3%-43.1%). Only 48.3% of referred patients started the transplant evaluation within 6 months of referral. In multivariable analyses, factors associated with referral vs evaluation start among those referred at any time differed. For example, black, non-Hispanic patients had a higher rate of referral (hazard ratio [HR]: 1.22; 95% confidence interval [CI]: 1.18-1.27), but lower evaluation start among those referred (HR: 0.93; 95% CI: 0.88-0.98), vs white non-Hispanic patients. Barriers to transplant varied by step, and national surveillance data should be collected on early transplant steps to improve transplant access.

Keywords: clinical research/practice; dialysis; disparities; epidemiology; ethnicity/race; health services and outcomes research; kidney transplantation/nephrology; patient referral.

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Conflict of interest statement

DISCLOSURE

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Figures

FIGURE 1
FIGURE 1
Flow diagram of study inclusion and exclusion criteria for study population (2012–2018)
FIGURE 2
FIGURE 2
Percentage of patients referred for kidney transplantation (orange) within 1 y of dialysis start and the percentage of patients who start the evaluation (blue) among incident end-stage kidney disease (ESKD) patients within dialysis facilities in Georgia, North Carolina, and South Carolina: 2012–2016, followed through February 2018 [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

References

    1. United States Renal Data System. 2018 USRDS annual data report: Epidemiology of kidney disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2018.
    1. King KL, Husain SA, Jin Z, Brennan C, Mohan S. Trends in disparities in preemptive kidney transplantation in the United States. Clin J Am Soc Nephrol. 2019;14(10):1500–1511. - PMC - PubMed
    1. Patzer RE, Plantinga L, Krisher J, Pastan SO. Dialysis facility and network factors associated with low kidney transplantation rates among United States dialysis facilities. Am J Transplant. 2014; 14(7):1562–1572. - PMC - PubMed
    1. Department of Health and Human Services. Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program. In: Services CfMaM, ed. Washington, DC: 2018. - PubMed
    1. Patzer RE, Plantinga LC, Paul S, et al. Variation in dialysis facility referral for kidney transplantation among patients with end-stage renal disease in Georgia. JAMA. 2015;314(6):582–594. - PMC - PubMed

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