Longer Distance From Dialysis Facility to Transplant Center Is Associated With Lower Access to Kidney Transplantation

Whelan, Adrian M; Johansen, Kirsten L.; McCulloch, Charles E.; Adelmann, Dieter; Niemann, Claus U.; Roll, Garrett R.; Siyahian, Salpi; Grimes, Barbara; Ku, Elaine

doi:10.1097/txd.0000000000001048

Cited by 5 publications

(4 citation statements)

References 22 publications

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“…Studies using the USRDS data have demonstrated low rates of addition to the waitlist among women, minorities, patients receiving dialysis at facilities located further away from transplant centers, and the elderly [ 58 – 60 ]. Among UNOS regions, racial disparities appear to be more pronounced where Black patients comprise a large proportion of the end stage renal disease (ESRD) population [ 61 ].…”

Section: Resultsmentioning

confidence: 99%

A scoping review of inequities in access to organ transplant in the United States

Park

Jones

Kaplan

et al. 2022

Int J Equity Health

107

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Background Organ transplant is the preferred treatment for end-stage organ disease, yet the majority of patients with end-stage organ disease are never placed on the transplant waiting list. Limited access to the transplant waiting list combined with the scarcity of the organ pool result in over 100,000 deaths annually in the United States. Patients face unique barriers to referral and acceptance for organ transplant based on social determinants of health, and patients from disenfranchised groups suffer from disproportionately lower rates of transplantation. Our objective was to review the literature describing disparities in access to organ transplantation based on social determinants of health to integrate the existing knowledge and guide future research. Methods We conducted a scoping review of the literature reporting disparities in access to heart, lung, liver, pancreas and kidney transplantation based on social determinants of health (race, income, education, geography, insurance status, health literacy and engagement). Included studies were categorized based on steps along the transplant care continuum: referral for transplant, transplant evaluation and selection, living donor identification/evaluation, and waitlist outcomes. Results Our search generated 16,643 studies, of which 227 were included in our final review. Of these, 34 focused on disparities in referral for transplantation among patients with chronic organ disease, 82 on transplant selection processes, 50 on living donors, and 61 on waitlist management. In total, 15 studies involved the thoracic organs (heart, lung), 209 involved the abdominal organs (kidney, liver, pancreas), and three involved multiple organs. Racial and ethnic minorities, women, and patients in lower socioeconomic status groups were less likely to be referred, evaluated, and added to the waiting list for organ transplant. The quality of the data describing these disparities across the transplant literature was variable and overwhelmingly focused on kidney transplant. Conclusions This review contextualizes the quality of the data, identifies seminal work by organ, and reports gaps in the literature where future research on disparities in organ transplantation should focus. Future work should investigate the association of social determinants of health with access to the organ transplant waiting list, with a focus on prospective analyses that assess interventions to improve health equity.

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Section: Resultsmentioning

confidence: 99%

A scoping review of inequities in access to organ transplant in the United States

Park

Jones

Kaplan

et al. 2022

Int J Equity Health

107

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“…Limited availability of dialysis facilities may limit the access to maintenance dialysis for kidney failure patients and could ultimately impact their health outcomes, such as ability to receive a kidney transplant. 7 Additionally, other work has found longer travel times among kidney failure patients are associated with greater adjusted relative risk of death as well as lower perceived quality of life. 17…”

Section: Discussionmentioning

confidence: 99%

“…Although several studies have evaluated the impact of limited dialysis facility access, few studies have investigated the distribution and patient-level characteristics on the basis of availability of dialysis facilities. Limited availability of dialysis facilities may limit the access to maintenance dialysis for kidney failure patients and could ultimately impact their health outcomes, such as ability to receive a kidney transplant (7). Additionally, other work has found that longer travel times among kidney failure patients are associated with greater adjusted relative risk of death and lower perceived quality of life (17).…”

Section: Discussionmentioning

confidence: 99%

“…More granular, county-level estimates can inform local policy decisions, resource allocation, or targeted interventions. Although studies have described the health effects of increased travel distance in other care settings, such as transplant outcomes, emergency room utilization, and progression of cancer staging, less focus has been placed on the country-wide, county-level supply of dialysis facilities and distance traveled (7)(8)(9). One study examining geographic disparities in dialysis patient travel suggests that rural patients travel longer distances than dialysis patients in urban areas (10).…”

Section: Introductionmentioning

confidence: 99%

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County-Level Dialysis Facility Supply and Distance Traveled to Facilities among Incident Kidney Failure Patients

Velázquez¹,

Thorsness²,

Trivedi³

et al. 2022

Kidney360

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Background: The availability of dialysis facilities and distance traveled to receive care can impact health outcomes for patients with newly onset kidney failure. We examine recent changes in county-level number of dialysis facilities between 2012 and 2019, and assess the association between county-level dialysis facility supply and the distance incident kidney failure patients travel to receive care. Methods: We conducted a cross-sectional study of 828,427 adult patients initiating in-center hemodialysis for incident kidney failure between January 1, 2012 and December 31, 2019. We calculated the annual county-level number of dialysis facilities, and counties were categorized as having 0, 1, 2, or 3 or more dialysis facilities at the time of treatment initiation. We then measured the distance traveled between a patient's home address and dialysis facility at treatment initiation (in miles) and evaluated the association between county-level number of dialysis facilities and distance traveled to initiate treatment. Results: The average annual county-level number of facilities increased from 1.8 to 2.3 between 2012 and 2019. In our study period, 4.8% of incident adult kidney failure patients resided in a county that had zero dialysis facilities between 2012 to 2019. Compared to counties with three or more dialysis facilities, patients living in counties with no facilities in our study period traveled 14.3 miles (95% CI: 13.4 to 15.2) further for treatment. Conclusions: Kidney failure patients in counties that had no dialysis facilities traveled further, limiting their access to dialysis. Counties with no dialysis facilities at the end of the study period were more rural and had higher poverty than other counties.

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Increased volume of organ offers and decreased efficiency of kidney placement under circle-based kidney allocation

Cron

Husain

King

et al. 2023

American Journal of Transplantation

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Longer Distance From Dialysis Facility to Transplant Center Is Associated With Lower Access to Kidney Transplantation

Cited by 5 publications

References 22 publications

A scoping review of inequities in access to organ transplant in the United States

A scoping review of inequities in access to organ transplant in the United States

County-Level Dialysis Facility Supply and Distance Traveled to Facilities among Incident Kidney Failure Patients

Increased volume of organ offers and decreased efficiency of kidney placement under circle-based kidney allocation

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