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Variation in Dialysis Facility Referral for Kidney Transplantation Among Patients With End-Stage Renal Disease in Georgia.
JAMA. 2015 Aug 11; 314(6):582-94.JAMA

Abstract

IMPORTANCE

Dialysis facilities in the United States are required to educate patients with end-stage renal disease about all treatment options, including kidney transplantation. Patients receiving dialysis typically require a referral for kidney transplant evaluation at a transplant center from a dialysis facility to start the transplantation process, but the proportion of patients referred for transplantation is unknown.

OBJECTIVE

To describe variation in dialysis facility-level referral for kidney transplant evaluation and factors associated with referral among patients initiating dialysis in Georgia, the US state with the lowest kidney transplantation rates.

DESIGN, SETTING, AND PARTICIPANTS

Examination of United States Renal Data System data from a cohort of 15,279 incident, adult (18-69 years) patients with end-stage renal disease from 308 Georgia dialysis facilities from January 2005 to September 2011, followed up through September 2012, linked to kidney transplant referral data collected from adult transplant centers in Georgia in the same period.

MAIN OUTCOMES AND MEASURES

Referral for kidney transplant evaluation within 1 year of starting dialysis at any of the 3 Georgia transplant centers was the primary outcome; placement on the deceased donor waiting list was also examined.

RESULTS

The median within-facility percentage of patients referred within 1 year of starting dialysis was 24.4% (interquartile range, 16.7%-33.3%) and varied from 0% to 75.0%. Facilities in the lowest tertile of referral (<19.2%) were more likely to treat patients living in high-poverty neighborhoods (absolute difference, 21.8% [95% CI, 14.1%-29.4%]), had a higher patient to social worker ratio (difference, 22.5 [95% CI, 9.7-35.2]), and were more likely nonprofit (difference, 17.6% [95% CI, 7.7%-27.4%]) compared with facilities in the highest tertile of referral (>31.3%). In multivariable, multilevel analyses, factors associated with lower referral for transplantation, such as older age, white race, and nonprofit facility status, were not always consistent with the factors associated with lower waitlisting.

CONCLUSIONS AND RELEVANCE

In Georgia overall, a limited proportion of patients treated with dialysis were referred for kidney transplant evaluation between 2005 and 2011, but there was substantial variability in referral among facilities. Variables associated with referral were not always associated with waitlisting, suggesting that different factors may account for disparities in referral.

Links

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Authors+Show Affiliations

Patzer RE
Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia2Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia3Emory Transplant Center, Atlanta, Georgia.
Plantinga LC
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia4Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Paul S
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.
Gander J
Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Krisher J
Southeastern Kidney Council Inc of End Stage Renal Disease Network 6, Raleigh, North Carolina.
Sauls L
Southeastern Kidney Council Inc of End Stage Renal Disease Network 6, Raleigh, North Carolina.
Gibney EM
Piedmont Transplant Institute, Piedmont Healthcare, Atlanta, Georgia.
Mulloy L
Division of Nephrology, Department of Medicine, Georgia Regents University, Augusta.
Pastan SO
Emory Transplant Center, Atlanta, Georgia4Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.

MeSH

AdolescentAdultAgedAmbulatory Care FacilitiesCohort StudiesFemaleGeorgiaHumansKidney Failure, ChronicKidney TransplantationMaleMiddle AgedPovertyReferral and ConsultationRenal DialysisWaiting ListsYoung Adult

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

26262796

Citation

Patzer, Rachel E., et al. "Variation in Dialysis Facility Referral for Kidney Transplantation Among Patients With End-Stage Renal Disease in Georgia." JAMA, vol. 314, no. 6, 2015, pp. 582-94.
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):582-94.
Patzer, R. E., Plantinga, L. C., Paul, S., Gander, J., Krisher, J., Sauls, L., Gibney, E. M., Mulloy, L., & Pastan, S. O. (2015). Variation in Dialysis Facility Referral for Kidney Transplantation Among Patients With End-Stage Renal Disease in Georgia. JAMA, 314(6), 582-94. https://doi.org/10.1001/jama.2015.8897
Patzer RE, et al. Variation in Dialysis Facility Referral for Kidney Transplantation Among Patients With End-Stage Renal Disease in Georgia. JAMA. 2015 Aug 11;314(6):582-94. PubMed PMID: 26262796.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Variation in Dialysis Facility Referral for Kidney Transplantation Among Patients With End-Stage Renal Disease in Georgia. AU - Patzer,Rachel E, AU - Plantinga,Laura C, AU - Paul,Sudeshna, AU - Gander,Jennifer, AU - Krisher,Jenna, AU - Sauls,Leighann, AU - Gibney,Eric M, AU - Mulloy,Laura, AU - Pastan,Stephen O, PY - 2015/8/12/entrez PY - 2015/8/12/pubmed PY - 2015/8/20/medline SP - 582 EP - 94 JF - JAMA JO - JAMA VL - 314 IS - 6 N2 - IMPORTANCE: Dialysis facilities in the United States are required to educate patients with end-stage renal disease about all treatment options, including kidney transplantation. Patients receiving dialysis typically require a referral for kidney transplant evaluation at a transplant center from a dialysis facility to start the transplantation process, but the proportion of patients referred for transplantation is unknown. OBJECTIVE: To describe variation in dialysis facility-level referral for kidney transplant evaluation and factors associated with referral among patients initiating dialysis in Georgia, the US state with the lowest kidney transplantation rates. DESIGN, SETTING, AND PARTICIPANTS: Examination of United States Renal Data System data from a cohort of 15,279 incident, adult (18-69 years) patients with end-stage renal disease from 308 Georgia dialysis facilities from January 2005 to September 2011, followed up through September 2012, linked to kidney transplant referral data collected from adult transplant centers in Georgia in the same period. MAIN OUTCOMES AND MEASURES: Referral for kidney transplant evaluation within 1 year of starting dialysis at any of the 3 Georgia transplant centers was the primary outcome; placement on the deceased donor waiting list was also examined. RESULTS: The median within-facility percentage of patients referred within 1 year of starting dialysis was 24.4% (interquartile range, 16.7%-33.3%) and varied from 0% to 75.0%. Facilities in the lowest tertile of referral (<19.2%) were more likely to treat patients living in high-poverty neighborhoods (absolute difference, 21.8% [95% CI, 14.1%-29.4%]), had a higher patient to social worker ratio (difference, 22.5 [95% CI, 9.7-35.2]), and were more likely nonprofit (difference, 17.6% [95% CI, 7.7%-27.4%]) compared with facilities in the highest tertile of referral (>31.3%). In multivariable, multilevel analyses, factors associated with lower referral for transplantation, such as older age, white race, and nonprofit facility status, were not always consistent with the factors associated with lower waitlisting. CONCLUSIONS AND RELEVANCE: In Georgia overall, a limited proportion of patients treated with dialysis were referred for kidney transplant evaluation between 2005 and 2011, but there was substantial variability in referral among facilities. Variables associated with referral were not always associated with waitlisting, suggesting that different factors may account for disparities in referral. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/26262796/Variation_in_Dialysis_Facility_Referral_for_Kidney_Transplantation_Among_Patients_With_End_Stage_Renal_Disease_in_Georgia_ DB - PRIME DP - Unbound Medicine ER -