Barriers to Evaluation and Wait Listing for Kidney Transplantation

Schold, Jesse D.; Gregg, Jon A.; Harman, Jeffrey S.; Hall, Allyson G.; Patton, Pamela R.; Meier-Kriesche, Herwig Ulf

doi:10.2215/cjn.08620910

Cited by 151 publications

(168 citation statements)

References 28 publications

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“…Unlike findings from the US (32,43), patients at private for-profit centers did not have a lower chance of being waitlisted. Also in contrast to a US study (44), regional gross domestic product per capita and disposable household income per capita had no influence on waiting-list placement, nor did any of the health care supply indicators we studied. Because no other study has assessed the potential relation of the density of specialists, nephrologists, and general practitioners to access to renal transplant waiting lists, our findings cannot be compared with other countries.…”

Section: Discussioncontrasting

confidence: 94%

Individual and Regional Factors of Access to the Renal Transplant Waiting List in France in a Cohort of Dialyzed Patients

Bayat

Macher

Couchoud

et al. 2015

American Journal of Transplantation

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Several studies have investigated geographical variations in access to renal transplant waiting lists, but none has assessed the impact on these variations of factors at both the patient and geographic levels. The objective of our study was to identify medical and nonmedical factors at both these levels associated with these geographical variations in waiting-list placement in France. We included all incident patients aged 18-80 years in 11 French regions who started dialysis between January 1, 2006, and December 31, 2008. Both a multilevel Cox model with shared frailty and a competing risks model were used for the analyses. At the patient level, old age, comorbidities, diabetic nephropathy, non-autonomous first dialysis, and female gender were the major determinants of a lower probability of being waitlisted. At the regional level, the only factor associated with this probability was an increase in the number of patients on the waiting list from 2005 to 2009. This finding supports a slight but significant impact of a regional organ shortage on waitlisting practices. Our findings demonstrate that patients' age has a major impact on waitlisting practices, even for patients with no comorbidity or disability, whose survival would likely be improved by transplantation compared with dialysis.

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Section: Discussioncontrasting

confidence: 94%

Individual and Regional Factors of Access to the Renal Transplant Waiting List in France in a Cohort of Dialyzed Patients

Bayat

Macher

Couchoud

et al. 2015

American Journal of Transplantation

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“…Transplant educators in dialysis centers (predominantly nurses and dialysis social workers) themselves report having limited time and knowledge to successfully educate patients about transplantation (9), with educators at for-profit dialysis centers less likely to administer high-quality, more intensive transplant educational strategies (e.g., one-on-one discussions) compared with nonprofit centers (6). Ultimately, dialysis centers with higher proportions of black and diabetic patients, more patients with lower incomes or less comprehensive insurance, and more patients undergoing hemodialysis versus other forms of dialysis, as well as centers in neighborhoods with lower socioeconomic status and with fewer transplant centers nearby, have lower wait-listing and transplant rates (10)(11)(12)(13). However, because CMS does not capture information about the specific delivery of transplant education within a center, less is known about the variation in educational practices across centers or the effect of specific education practices within these dialysis centers on wait-listing rates.…”

Section: Introductionmentioning

confidence: 99%

Assessing Transplant Education Practices in Dialysis Centers

Waterman

Peipert

Goalby

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives The Centers for Medicare & Medicaid Services (CMS) requires that dialysis centers inform new patients of their transplant options and document compliance using the CMS-2728 Medical Evidence Form (Form-2728). This study compared reports of transplant education for new dialysis patients reported to CMS with descriptions from transplant educators (predominantly dialysis nurses and social workers) of their centers' quantity of and specific educational practices. The goal was to determine what specific transplant education occurred and whether provision of transplant education was associated with center-level variation in transplant wait-listing rates.Design, setting, participants, & measurements Form-2728 data were drawn for 1558 incident dialysis patients at 170 centers in the Heartland Kidney Network (Iowa, Kansas, Missouri, and Nebraska) in 2009-2011; educators at these centers completed a survey describing their transplant educational practices. Educators' own survey responses were compared with Form-2728 reports for patients at each corresponding center. The association of quantity of transplant education practices used with wait-listing rates across dialysis centers was examined using multivariable negative binomial regression.Results According to Form-2728, 77% of patients (n=1203) were informed of their transplant options within 45 days. Educators, who reported low levels of transplant knowledge themselves (six of 12 questions answered correctly), most commonly reported giving oral recommendations to begin transplant evaluation (988 informed patients educated, 81% of centers) and referrals to external transplant education programs (959 informed patients educated, 81% of centers). Only 18% reported having detailed discussions about transplant with their patients. Compared with others, centers that used more than three educational activities (incident rate ratio, 1.36; 95% confidence interval, 1.07 to 1.73) had higher transplant wait-listing rates.Conclusions While most educators inform new patients that transplant is an option, dialysis centers with higher wait-listing rates use multiple transplant education strategies.

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“…For example, less-modifiable patient characteristics, including being a man (10,12), being younger (9,10,(12)(13)(14), having higher levels of formal education (14,15), having better health insurance (11,(13)(14)(15), being employed (15), having a higher income (4,13), and having a primary care physician (11,16), have all been shown to be associated with completion of transplant evaluation and receipt of transplant. The majority of studies assessing patient characteristics associated with successful transplant outcomes rely on publicly available national databases like those databases from the Scientific Registry of Transplant Recipients (SRTR) or United States Renal Data System, which have limited measurement of more-modifiable patient characteristics.…”

Section: Introductionmentioning

confidence: 99%

Modifiable Patient Characteristics and Racial Disparities in Evaluation Completion and Living Donor Transplant

Waterman

Peipert

Hyland

et al. 2013

Clinical Journal of the American Society of Nephrology

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163

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SummaryBackground and objectives To reduce racial disparities in transplant, modifiable patient characteristics associated with completion of transplant evaluation and receipt of living donor kidney transplant must be identified.Design, setting, participants, & measurements From 2004 to 2007, 695 black and white patients were surveyed about 15 less-modifiable and 10 more-modifiable characteristics at evaluation onset; whether they had completed evaluation within 1 year and received living donor kidney transplants by 2010 was determined. Logistic regression and competing risks time-to-event analysis were conducted to determine the variables that predicted evaluation completion and living donor kidney transplant receipt.Results Not adjusting for covariates, blacks were less likely than whites to complete evaluation (26.2% versus 51.8%, P,0.001) and receive living donor kidney transplants (8.7% versus 21.9%, P,0.001). More-modifiable variables associated with completing evaluation included more willing to be on the waiting list (odds ratio=3.4, 95% confidence interval=2.1, 5.7), more willing to pursue living donor kidney transplant (odds ratio=2.7, 95% confidence interval=1.8, 4.0), having access to more transplant education resources (odds ratio=2.2, 95% confidence interval=1.5, 3.2), and having greater transplant knowledge (odds ratio=1.8, 95% confidence interval=1.2, 2.7). Patients who started evaluation more willing to pursue living donor kidney transplant (hazard ratio=4.3, 95% confidence interval=2.7, 6.8) and having greater transplant knowledge (hazard ratio=1.2, 95% confidence interval=1.1, 1.3) were more likely to receive living donor kidney transplants.Conclusions Because patients who began transplant evaluation with greater transplant knowledge and motivation were ultimately more successful at receiving transplants years later, behavioral and educational interventions may be very successful strategies to reduce or overcome racial disparities in transplant.

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Barriers to Evaluation and Wait Listing for Kidney Transplantation

Cited by 151 publications

References 28 publications

Individual and Regional Factors of Access to the Renal Transplant Waiting List in France in a Cohort of Dialyzed Patients

Individual and Regional Factors of Access to the Renal Transplant Waiting List in France in a Cohort of Dialyzed Patients

Assessing Transplant Education Practices in Dialysis Centers

Modifiable Patient Characteristics and Racial Disparities in Evaluation Completion and Living Donor Transplant

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