A Survey of Nephrologists’ Views on Preemptive Transplantation

Abstract

Background and objectives: Despite emerging evidence that preemptive transplantation is the best treatment modality for patients reaching end-stage renal disease (ESRD), it is underutilized. Nephrologists' views on preemptive transplantation are explored herein.Design, setting, participants, & measurements: A web-based survey elicited barriers to preemptive transplantation as perceived by nephrologists as well as demographic and practice variables associated with a favorable attitude toward preemptive transplantation.Results: Four hundred seventy-six of 5,901 eligible nephrologists responded (8% participation rate). Seventy-one percent of respondents agreed that preemptive transplantation is the best treatment modality for eligible chronic kidney disease (CKD) patients reaching ESRD, 69% reported that late referrals did not allow enough time for patients to be evaluated for preemptive transplantation, and 50% stated that there was too much delay between a patient's referral and the time the patient was seen at the transplant center. Nephrologists agreed to a lesser extent that they should be held accountable for CKD patients' education (26%) and preemptive transplant referrals (23%). The most important patient factors considered when deciding not to discuss preemptive transplant were poor health status (70%), lack of compliance (69%), other medical problems (51%), being too old (40%), lack of prescription coverage (37%), and lack of health insurance to cover the costs of the procedure (36%).Conclusions: Surveyed nephrologists consider preemptive transplantation as the optimal treatment modality for eligible patients. Late referral, patient health and insurance status, and delayed transplant center evaluation are perceived as major barriers to preemptive transplantation.

Early Requirement for RRT in Children at Presentation in the United Kingdom: Association with Transplantation and Survival

“…LR will also delay listing for transplantation as work-up is delayed and reduce the chance of pre-emptive transplantation (16,17). Published data regarding the prevalence or impact of LR in children is scarce (18)(19)(20)(21); as are any United Kingdom-specific recommendations regarding optimal timing of referral for children with CKD to a pediatric nephrologist.…”

Barriers to Preemptive Renal Transplantation

“…10 Similarly, employed status, which was found in this study to be associated with presentation predialysis, may reflect access to more medical information compared to other patients who are unemployed or retired. In this regard, poverty has been linked to an increased time from starting dialysis to transplant referral.…”

Preemptive transplantation and the transplant first initiative

“…Medicare coverage appears to be an impediment to PKT for those waitlisted at less than 64 years of age [23]. In alignment with USRDS data, nephrologists report that impediments to early transplantation include late referral to their practice and too much delay between a patient's referral and the time the patient is seen at the transplant center [25]. Individual patient characteristics also impact nephrology referral for transplantation.…”

“…Individual patient characteristics also impact nephrology referral for transplantation. Nephrologists more often decide not to discuss PKT if the patient has poor health status, is nonadherent, has multiple medical problems, is 'too old', has no prescription drug coverage and has inadequate health insurance to cover the costs of transplant [25]. Likely some of these concerns have come directly or indirectly from the transplant centers themselves.…”