Medical and non-medical determinants of access to renal transplant waiting list in a French community-based network of care

Bayat, Sahar; Frimat, Luc; Thilly, Nathalie; Loos, Carole; Briançon, Serge; Kessler, Michèle

doi:10.1093/ndt/gfl329

Cited by 71 publications

(55 citation statements)

References 27 publications

(54 reference statements)

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“…Our study also confirms previous results about the association between old age and poor access to the waiting list, reported in Lorraine (23) and in other countries (19,25,26,29,30). Compared to patients aged l8-39 years, those older than 70 years were 97.5% less likely to be placed on the waiting list, after adjustment for other patient-level and region-level factors.…”

Section: Discussionsupporting

confidence: 91%

“…The impact of cardiovascular comorbidities on waitlisting confirms the results of the previous study in Lorraine (23). Similarly patients with diabetes and those with an active malignancy, respiratory disease, or physical or psychiatric disabilities at dialysis initiation were less likely to be placed on the waiting list, after adjustment for other patient-level and region-level factors.…”

Section: Discussionsupporting

confidence: 83%

“…As shown in the UK (25) and in contrast to reports from Lorraine (23) and Scotland (30), treatment and follow-up at public university hospital centers, all of them performing transplantation, were not associated with waiting-list placement. Unlike findings from the US (32,43), patients at private for-profit centers did not have a lower chance of being waitlisted.…”

Section: Discussionmentioning

confidence: 53%

“…But the large regional differences in the prevalence of waitlisted patients prevent any profound change in allocation policy without first assessing waitlisting practices. This prompted us to extend the scope of a previous study of medical and nonmedical determinants of placement on a waiting list for kidney transplantation in the region of Lorraine (23). Here we examine these determinants from a multiregional perspective and include additional patient-level and region-level factors.…”

Section: Introductionmentioning

confidence: 99%

“…Similarly, a wide variety of patient-level factors have been associated with access to renal transplant waiting lists, including not only medical factors (diabetes, cardiovascular disease and other comorbidities, and causes of ESRD), but also nonmedical factors such as gender and race/ethnicity (23)(24)(25)(26)(27)(28)(29)(30)(31). Studies have also shown center-level factors (private ownership of dialysis facilities, size of renal unit, and listing practice for living donor transplantation) to be related to access to waiting lists (25,32).…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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Diabetic kidney disease versus non‐diabetic kidney disease in type 2 diabetic patients on dialysis: An observational cohort

Delautre

Hannedouche

Couchoud

et al. 2022

Endocrino Diabet & Metabol

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Background: All chronic kidney diseases in diabetic patients are not diabetic kidney diseases. The objective was to compare the clinical characteristics, survival and access to transplantation in diabetic patients starting dialysis and classified either as diabetic kidney disease (DKD) or non-diabetic kidney disease in diabetic patients (NDKD).Methods: We used the nationwide French REIN registry to analyse baseline clinical characteristics at dialysis inception and outcomes defined as kidney transplantation, deaths and their causes. The probability of death or transplantation was analysed using a multivariate Cox model and the Fine and Gray competing for risk model (sdHT). Results:We included 65,136 patients from January 2009 to December 2015 with a median follow-up of 31 months. The cumulative incidence of kidney transplantation over eight years was 46.9% (44.8-48.9) in non-diabetic patients (ND), higher than the 19.3% (17.5-21.2) in the DKD group and 22.2% (18.4-26.7) in the NDKD group. The risk of death was significantly higher in the NDKD group than in the DKD group, even after accounting for the competing risk of transplantation (NDKD/sdHR 1.22; 95%CI 1.18-1.27; p < 0.005 vs. DKD/sdHR 1.12; 95%CI 1.08-1.16; p < 0.005 with adjustment for age, sex, major adverse cardiovascular events, cancer and chronic respiratory failure, compared to ND). Conclusions:In diabetic patients starting dialysis, patients in the DKD group had reduced access to kidney transplantation. NDKD patients had a higher risk of mortality than DKD. The distinction between DKD and NDKD should be accounted for in the plan of care of diabetic patients starting dialysis.

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Prédire l’accès à la liste d’attente de transplantation rénale: comparaison de deux méthodes de fouille de données

Bayat¹,

Cuggia²,

Rossille³

et al. 2009

Informatique Et Santé

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Medical and non-medical determinants of access to renal transplant waiting list in a French community-based network of care

Cited by 71 publications

References 27 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

Diabetic kidney disease versus non‐diabetic kidney disease in type 2 diabetic patients on dialysis: An observational cohort

Prédire l’accès à la liste d’attente de transplantation rénale: comparaison de deux méthodes de fouille de données

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