Improving Access to Kidney Transplantation: Perspectives From Dialysis and Transplant Staff in the Southeastern United States

Browne, Teri; McPherson, Laura; Retzloff, Samantha; Darius, Amandha; Wilk, Adam S.; Cruz, Alexandra La; Wright, Shannon; Pastan, Stephen O.; Gander, Jennifer C.; Берлин, А. А.; Patzer, Rachel E.

doi:10.1016/j.xkme.2021.04.017

Cited by 19 publications

(27 citation statements)

References 18 publications

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“…Thus, the marital relationship can be a protective factor in the access to information and in the health care of men. In addition, with the event of the transplant, families face the impact of the entire process, including the fact that their members stop carrying out their professional activities, as well as the children's school dropout, which directly impacts the routine and family organization (12)(13)(14)(15)20) .…”

Section: Discussionmentioning

confidence: 99%

“…It is known that CKD is related to socially defined factors such as population with low socioeconomic status, in social vulnerability and ethnic minorities. These groups face the coexistence of communicable and noncommunicable diseases, as well as the difficulty of initiating treatment in one of the RRTs (13)(14)(15)(16) .…”

Section: Introductionmentioning

confidence: 99%

“…Studies show (3)(4)(5)(6)(7) that despite the availability of a universal healthcare system, inequality in access to the waiting list for kidney transplantation (7) is evident, including in the different regions of the country (6)(7)(11)(12)(13)(14)(15)(16) . Therefore, regional studies on the reasons why individuals are not registered on the waiting list for kidney transplantation are needed.…”

Section: Introductionmentioning

confidence: 99%

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Reasons referred by individuals who were not on kidney transplantation waiting lists

Dall'Agnol

Schwartz

Zanín

et al. 2023

Rev. Gaúcha Enferm.

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Objective: To describe the reasons reported by individuals in hemodialysis that were not registered on kidney transplantation waiting lists. Methods: Cross-sectional study conducted in six renal replacement therapy services in Rio Grande do Sul, Brazil with 214 individuals undergoing hemodialysis who reported the reasons for not being registered on kidney transplantation waiting lists. The data collection was carried out through a questionnaire from March 2016 to March 2017. The Stata software was used to the statistical analysis and independence test. Results: The main reasons reported by the 214 individuals who were not registered on kidney transplantation waiting lists were due to the lack of information of the individuals, not wanting to be on list, due to morbidities and age. Conclusions: The lack of information was associated with the variables low education, male, ≤ 5 years of time since diagnosis and ≤ 5 years in renal replacement therapy. The reason for not wanting to be on the list was associated with the variables illiteracy and age.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reasons referred by individuals who were not on kidney transplantation waiting lists

Dall'Agnol

Schwartz

Zanín

et al. 2023

Rev. Gaúcha Enferm.

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“…In terms of comparing absolute effects between race categories, we identified that over half of the patients in all‐race hot spots were Hispanic (52%), while nearly one‐third (28%) were NHB, suggesting substantial racial inequities within the geographic disparities we identified. Policy changes and interventions, such as improving patient education on transplantation, standardizing patient referral, mandating universal transportation options for patients at transplant centers, and standardizing transplant eligibility across transplant centers may be viable solutions for reducing racial disparities 31–34 …”

Section: Discussionmentioning

confidence: 99%

“…Policy changes and interventions, such as improving patient education on transplantation, standardizing patient referral, mandating universal transportation options for patients at transplant centers, and standardizing transplant eligibility across transplant centers may be viable solutions for reducing racial disparities. [31][32][33][34] Future work examining wait list disparities should consider further integration of geospatial context and methods to better account for the geographic disparities identified in this work. Beyond wait-listing, the geographic clustering methods utilized in this study can be translated not only to other KT disparities, but also within wider organ transplant disparity studies.…”

Section: Discussionmentioning

confidence: 99%

Geographic hot spots of kidney transplant candidates wait‐listed post‐dialysis

Buchalter

Huml

Poggio

et al. 2022

Clinical Transplantation

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Introduction:Preemptive wait-listing of deceased donor kidney transplant (DDKT) candidates before maintenance dialysis increases the likelihood of transplantation and improves outcomes among transplant patients. Previous studies have identified substantial disparities in rates of preemptive listing, but a gap exists in examining geographic sources of disparities, particularly for sub-regional units. Identifying small area hot spots where delayed listing is particularly prevalent may more effectively inform both health policy and regionally appropriate interventions. Methods:We conducted a retrospective cohort study utilizing 2010-2020 Scientific Registry of Transplant Recipients (SRTR) data for all DDKT candidates to examine overall and race-stratified geospatial hot spots of post-dialysis wait-listing in U.S. zip code tabulation areas (ZCTA). Three geographic clustering methods were utilized to identify robust statistically significant hot spots of post-dialysis wait-listing.Results: Novel sub-regional hot spots were identified in the southeast, southwest, Appalachia, and California, with a majority existing in the southeast. Race-stratified results were more nuanced, but broadly reflected similar patterns. Comparing transplant candidates in hot spots to candidates in non-clusters indicated a strong association between residence in hot spots and high area deprivation (OR: 6.76, 95%CI: 6.52-7.02), indicating that improving access healthcare in these areas may be particularly beneficial. Conclusion:Our study identified overall and race-stratified hot spots with low rates of preemptive wait list placement in the U.S., which may be useful for prospective healthcare policy and interventions via targeting of these narrowly defined geographical areas.

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Dialysis Facility Staffing Ratios and Kidney Transplant Access Among Adolescents and Young Adults

Bicki,

Grimes,

McCulloch

et al. 2024

JAMA

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ImportancePatient to staff ratios vary across US dialysis facilities and have been associated with patient outcomes in older adults.ObjectiveTo determine whether patient to nurse or patient to social worker staff ratios are associated with access to kidney transplant for adolescents and young adults.Design, Setting, and ParticipantsRetrospective cohort study including patients aged 12 to 30 years who started dialysis between 2005 and 2019 at 8490 US facilities according to the US Renal Data System, the national end-stage kidney disease registry.ExposuresTime-updated quartile of patient to nurse and patient to social worker ratios at dialysis facilities.Main Outcomes and MeasuresFine-Gray models were used to relate the exposure to the incidence of waitlisting and kidney transplant, accounting for the competing risk of death. Subgroup analysis by age at dialysis initiation (&lt;22 vs ≥22 years) was performed. Follow-up was censored in January 2020.ResultsA total of 54 141 participants were included (median age, 25 years [IQR, 21-28]; 54.4% male; 4.3% of Asian race, 35.3% of non-Hispanic Black race). The median patient to staff ratios were 14.4 patients per nurse (IQR, 10.3-18.9) and 91.0 patients per social worker (IQR, 65.2-115.0). During a median follow-up of 2.6 years, 39.9% of patients (n = 21 598) received a transplant. In adjusted analysis, the highest (vs lowest) quartile of patient to nurse ratios was associated with 14% lower incidence of transplant (subhazard ratio [SHR], 0.86 [95% CI, 0.82-0.91]). The highest (vs lowest) quartile of patient to social worker ratios was associated with lower incidence of waitlisting (SHR, 0.95 [95% CI, 0.91-0.99]) and transplant (SHR, 0.85 [95% CI, 0.81-0.89]). For both staff ratios, there was an interaction with age at dialysis initiation, such that the association was more pronounced in patients starting dialysis at younger than 22 years (SHR, 0.71 [95% CI, 0.65-0.78] for the highest vs lowest quartile for nursing; SHR, 0.74 [95% CI, 0.68-0.80] for social work) compared with those 22 years and older (SHR, 1.00 [95% CI, 0.94-1.06] for nursing; SHR, 0.96 [95% CI, 0.91-1.02] for social work) for the outcome of transplant.Conclusions and RelevanceAdolescents and young adults receiving care at dialysis facilities with higher patient to staff ratios had reduced access to waitlisting and transplant, particularly if they were younger than 22 years of age at dialysis initiation.

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Improving Access to Kidney Transplantation: Perspectives From Dialysis and Transplant Staff in the Southeastern United States

Cited by 19 publications

References 18 publications

Reasons referred by individuals who were not on kidney transplantation waiting lists

Reasons referred by individuals who were not on kidney transplantation waiting lists

Geographic hot spots of kidney transplant candidates wait‐listed post‐dialysis

Dialysis Facility Staffing Ratios and Kidney Transplant Access Among Adolescents and Young Adults

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