Measuring quality in living donation and kidney transplantation: moving beyond survival metrics

Knoll, Greg; Fortin, Marie-Chantal; Gill, Jagbir; Grimshaw, Jeremy; Hartell, David; Karnabi, Priscilla; Parsons, Christina; Vorster, Hans; Kim, S. Joseph

doi:10.1016/j.kint.2020.07.014

Cited by 5 publications

(7 citation statements)

References 8 publications

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“…Recently, a multiphase framework encompassing a broad range of kidney transplant quality indicators, including timely and equitable access and efficiency measures, has been proposed. 36 Applying the criteria we developed can help ascertain the denominator over which transplant rates can be measured and compared between programs. Limited health care resources can then be deployed to best address gaps in access.…”

Section: Discussionmentioning

confidence: 99%

Using Administrative Health Care Databases to Identify Patients With End-Stage Kidney Disease With No Recorded Contraindication to Receiving a Kidney Transplant

Wang

Naylor

Luo³

et al. 2022

Can J Kidney Health Dis

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Background: Administrative health care databases can be efficiently analyzed to describe the degree to which patients with end-stage kidney disease (ESKD) have access to kidney transplantation. Measures of access to transplantation are better represented when restricting to only those patients eligible to receive a kidney transplant. The way administrative data can be used to assess kidney transplant eligibility in the absence of clinical data has not been well described. Objective: To demonstrate a method that uses administrative health care databases to identify patients with ESKD who have no recorded contraindication to receiving a kidney transplant. Design and setting: Population-based cohort study using linked administrative health care databases in Ontario, Canada. Patients: Adult patients with ESKD approaching the need for dialysis (predialysis) or receiving maintenance dialysis between January 1, 2013 and March 31, 2015 in Ontario, Canada. Measurements: Recipient of a kidney-only or kidney-pancreas transplant. Methods: We assessed more than 80 baseline characteristics, including demographic information, comorbidities, kidney-specific characteristics, and referral and listing criteria for kidney transplantation. We compared these characteristics between patients who did and did not receive a kidney transplant. Results: We included 23 642 patients with ESKD (11 195 who were predialysis and 12 447 receiving maintenance dialysis). Over a median follow-up of 3.2 years (25th, 75th percentile: 1.3, 5.6), 3215 (13.6%) received a kidney-only or kidney-pancreas transplant. Of the studied characteristics available in administrative databases, >97% of patients with one or more of these characteristics did not receive a kidney transplant during follow-up: ESKD-modified Charlson Comorbidity Index score ≥7 (a higher score represents greater comorbidity), home oxygen use, age above 75 years, dementia, living in a long-term care facility, receiving at least one physician house call in the past year, and a combination of select malignancies (ie, lung, lymphoma, cervical, colorectal, liver, active multiple myeloma, and bladder cancer). Using these combined criteria reduced the total number of patients from 23 642 to 12 539 with no recorded contraindications to transplant (a 47% reduction), while the proportion who received a kidney transplant changed from 13.6% (denominator of 23 642) to 24.9% (denominator of 12 539). Limitations: Administrative databases are unable to capture all the complexities of determining transplant eligibility. Conclusion: We identified several criteria available within administrative health care databases that can be used to identify patients with ESKD who have no recorded contraindications to kidney transplant. These criteria could be applied when reporting measures of access to kidney transplantation that require knowledge of transplant eligibility.

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Section: Discussionmentioning

confidence: 99%

Using Administrative Health Care Databases to Identify Patients With End-Stage Kidney Disease With No Recorded Contraindication to Receiving a Kidney Transplant

Wang

Naylor

Luo³

et al. 2022

Can J Kidney Health Dis

View full text Add to dashboard Cite

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“…Our study complements ongoing work that aims to achieve consensus on which indicators should be used in kidney transplantation across Canada. 25 …”

Section: Discussionmentioning

confidence: 99%

“…The first was a Canadian consensus workshop of key stakeholders in transplantation (physicians, patient representatives, allied health) that reviewed potential quality indicators according to predefined criteria (eg, relevant, actionable, measurable) and provided a recommendation of essential, optional, or exclude. 25 The second study was a Delphi panel to achieve consensus on quality indicators used to measure the efficiency of the living kidney donor evaluation. 30 An important observation from the indicators selected in these 2 studies is that the equity domain of quality continues to lack representation, as confirmed in our environmental scan.…”

Section: Discussionmentioning

confidence: 99%

An Environmental Scan and Evaluation of Quality Indicators Across Canadian Kidney Transplant Centers

Glavinovic

Vinson

Silver

et al. 2021

Can J Kidney Health Dis

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Background: Kidney transplantation is the optimal treatment for an individual requiring kidney replacement therapy, resulting in improved survival and quality of life while costing the health care system less than maintenance dialysis. Achieving and maintaining a kidney transplant requires extensive coordination of several different health care services. To improve the quality of kidney transplant care, quality metrics or indicators that encompass all aspects of the individual’s journey to transplant should be measured in a standardized fashion. Objective: To identify, categorize, and evaluate strengths and weaknesses of kidney transplant quality indicators currently being used across Canada. Design: An environmental scan of quality indicators being used by kidney organizations and programs. Setting: A 16-member volunteer pan-Canadian panel with expertise in nephrology, transplant, and quality improvement. Sample: Transplant programs, as well as provincial transplant and kidney agencies across Canada. Methods: Indicators were first categorized based on the period of transplant care and then using the Institute of Medicine and Donabedian frameworks. A 4-member subcommittee rated each indicator using a modified version of the Delphi consensus technique based on the American College of Physician/Agency for Healthcare Research and Quality criteria. Consensus ratings were subsequently shared with the entire 16-member panel for additional comments. Results: We identified 46 measures related to transplant care across 7 Canadian provinces (9 referral and evaluation, 9 waitlist activity and outcomes, 6 hospitalization for transplant surgery, 12 posttransplant care, 6 organ utilization, 4 living donor). We rated 24 indicators (52%) as necessary to distinguish high-quality from low-quality care, most of which measured effective (n = 10) or efficient (n = 6) care. Only 7 (15%) of 46 indicators evaluated person-centered or equitable care. Fourteen common indicators were measured by 5 of 7 provinces, 10 of which were deemed “necessary,” measuring safe (n = 2), effective (n = 5), efficient (n = 2), and equitable (n = 1) care. Limitations: The panel lacked patient and allied health representation. Conclusions: There are a large number of kidney transplant quality indicators currently being used in Canada, some of which are common across provinces and focus primarily on measuring effective care. Person-centered and equitable care indicators were lacking, and only half of these indicators were deemed “necessary” for quality improvement. Our results should complement ongoing work to achieve national consensus on the standardization of quality indicators in kidney transplantation.

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“…However, quality measures for living kidney donation include among others, equitability (number of transplantation performed) and timeliness (delay to assess suitability for living kidney donation) [4]. A higher number of transplantations and a shorter evaluation time of donors are both considered as positive markers.…”

Section: Introductionmentioning

confidence: 99%

Living kidney donor evaluation for all candidates with normal estimated GFR for age

et al. 2021

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Multiple days assessments are frequent for the evaluation of candidates to living kidney donation, combined with an early GFR estimation (eGFR). Living kidney donation is questionable when eGFR is <90 ml/min/1.73 m 2 (KDIGO guidelines) or 80 ml/min/1.73 m 2 (most US centres). However, age-related GFR decline results in a lower eGFR for older candidates. That may limit the number of older kidney donors. Yet, continuing the screening with a GFR measure increases the number of eligible donors. We hypothesized that in-depth screening should be proposed to all candidates with a normal eGFR for age. We compared the evolution of eGFR after donation between three groups of predonation eGFR: normal for age (S age ) higher than 90 or 80 ml/min/1.73 m 2 (S 90 and S 80, respectively); across three age groups (<45, 45-55, >55 years) in a population of 1825 French living kidney donors with a median follow-up of 5.9 years. In donors younger than 45, postdonation eGFR, absolute-and relative-eGFR variation were not different between the three groups. For older donors, postdonation eGFR was higher in S 90 than in S 80 or S age but other comparators were identical. Postdonation eGFR slope was comparable between all groups. Our results are in favour of in-depth screening for all candidates to donation with a normal eGFR for age.

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Measuring quality in living donation and kidney transplantation: moving beyond survival metrics

Cited by 5 publications

References 8 publications

Using Administrative Health Care Databases to Identify Patients With End-Stage Kidney Disease With No Recorded Contraindication to Receiving a Kidney Transplant

Using Administrative Health Care Databases to Identify Patients With End-Stage Kidney Disease With No Recorded Contraindication to Receiving a Kidney Transplant

An Environmental Scan and Evaluation of Quality Indicators Across Canadian Kidney Transplant Centers

Living kidney donor evaluation for all candidates with normal estimated GFR for age

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