Barriers to Preemptive Renal Transplantation

Knight, Richard J.; Teeter, Larry D.; Graviss, Edward A.; Patel, Samir J.; DeVos, J.; Moore, Linda W.; Gaber, A. Osama

doi:10.1097/tp.0000000000000357

Cited by 23 publications

(21 citation statements)

References 13 publications

(13 reference statements)

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“…Similarly, educational level and insurance status did not affect the rate of PreKTx. Knight and colleagues 13 also reported the importance of patient education to achieve PreKTx, though their data also emphasized referral by a transplant nephrologist. In the current study, individual self-identified barriers to transplantation did not adversely affect the rate of PreKTx, but the presence of multiple self-identified barriers was more strongly associated with non-PreKTx.…”

Section: Discussionmentioning

confidence: 99%

“… 12 Prior studies have also emphasized the importance of early patient education by providers as a means of increasing rates of PreKTx. 13 Indeed, focused interventions consisting of specialized chronic kidney disease clinics have been able to increase the number of eligible patients referred for transplant, including a large number of preemptive referrals. 14 However, few studies have asked patients themselves about their perceived barriers to achieving PreKTx.…”

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confidence: 99%

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Identifying Barriers to Preemptive Kidney Transplantation in a Living Donor Transplant Cohort

Helmick

Jay

Price

et al. 2018

Transplantation Direct

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BackgroundDespite substantial evidence demonstrating clear benefit, rates of preemptive kidney transplantation (PreKTx) remain low in the United States. Our goal was to identify barriers to PreKTx.MethodsUsing a telephone-administered questionnaire including questions about barriers, timing of referral, timing of education, we retrospectively studied first living donor kidney transplant recipients (2006-2010) at Mayo Clinic, Rochester, MN. Of 235 patients, 145 (62%) responded to the questionnaire (74 PreKTx and 71 non-PreKTx). We compared categorical data with Fisher exact test and median times with Wilcoxon rank sum test.ResultsPolycystic kidney disease (PCKD), longer median time between diagnosis and transplant, and time between education about transplant and transplant correlated with PreKTx (P < 0.01). The presence of at least 1 patient-identified barrier (lack of referral, financial barriers, medical barriers, no identified living donor and donor evaluation delays) was associated with non-PreKTx (0.034) though no single barrier predominated. Age, education level, insurance status and source of referral (primary care, nephrology, and nonphysician referral) were not associated with the rate of PreKTx. Univariate logistic regression identified white race, PCKD, and increased time from diagnosis as factors favoring PreKTx; PCKD and increased time remained significant factors after multivariate analysis.ConclusionsEven among a patient population that is primarily white, educated, and has a spouse or first-degree relative donor, PreKTx rates remain concerningly low. Increased time between diagnosis or education and transplant are predictors of PreKTx. Greater emphasis on transplant education earlier in the stages of chronic kidney disease and community outreach from transplant centers may help to increase the rate of PreKTx.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Identifying Barriers to Preemptive Kidney Transplantation in a Living Donor Transplant Cohort

Helmick

Jay

Price

et al. 2018

Transplantation Direct

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“…This is in keeping with previous research that suggests that socioeconomically deprived individuals are less likely to receive a pre-emptive kidney transplant. 17,18,[47][48][49] This may reflect the association of SED with more rapid progression of renal disease towards renal failure, 50 later presentation to secondary care 51,52 and later listing for transplantation. 43,44,53,54 Qualitative work also suggests that a lack of a long-term health perspective might mean that LDKTs aren't considered until a situation makes it of importance in the short-term.…”

Section: Socioeconomic Deprivation and Living Kidney Donationmentioning

confidence: 99%

A multicenter cohort study of potential living kidney donors provides predictors of living kidney donation and non-donation

Bailey

Tomson

MacNeill

et al. 2017

Kidney International

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This multicenter prospective potential living kidney donor cohort study investigated which sociodemographic and other factors predict progression to living kidney donation or donor withdrawal as little is known on this topic. Therefore, we examined data on individuals undergoing living donor assessment at seven hospitals in the United Kingdom. Multivariable logistic regression was used to explore the relationships between donor and recipient characteristics and likelihood of kidney donation. A total of 805 individuals presented for directed donation to 498 intended recipients, of which 112 received a transplant from a living donor. Potential donors were less likely to donate if their intended recipient was female rather than male with an odds ratio of 0.60, a friend rather than relative 0.18, or had renal failure due to a systemic disease rather than another cause 0.41. The most socioeconomically deprived quintile was less likely to donate than the least 0.49, but the trend with deprivation was consistent with chance. Higher body mass index was associated with a lower likelihood of donation (odds ratio per each kg/m increase, 0.92). Younger potential donors (odds ratio per each year increase 0.97), those of nonwhite ethnicity 2.98, and friend donors 2.43 were more likely to withdraw from work-up. This is the first study in the United Kingdom of potential living kidney donors to describe predictors of non-donation. Qualitative work with individuals who withdraw might identify possible ways of supporting those who wish to donate but experience difficulties doing so.

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“…11 As education about transplantation has not yet been standardized, 45 use of Infórmate may help to achieve that aim. As education is pivotal to increasing preemptive transplantation, 46 patients with ESRD should be provided with as much education as possible prior to initiating renal replacement therapy. Communicating about the availability of Infórmate early in patients' chronic kidney disease (CKD) may foster preemptive transplantation.…”

Section: Discussionmentioning

confidence: 99%

A Website Intervention to Increase Knowledge About Living Kidney Donation and Transplantation Among Hispanic/Latino Dialysis Patients

et al. 2016

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Barriers to Preemptive Renal Transplantation

Cited by 23 publications

References 13 publications

Identifying Barriers to Preemptive Kidney Transplantation in a Living Donor Transplant Cohort

Identifying Barriers to Preemptive Kidney Transplantation in a Living Donor Transplant Cohort

A multicenter cohort study of potential living kidney donors provides predictors of living kidney donation and non-donation

A Website Intervention to Increase Knowledge About Living Kidney Donation and Transplantation Among Hispanic/Latino Dialysis Patients

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