Rates of Solid-Organ Wait-listing, Transplantation, and Survival Among Residents of Rural and Urban Areas

Axelrod, David A.; Guidinger, Mary K.; Finlayson, Samuel R.G.; Schaubel, Douglas E.; Goodman, David C.; Chobanian, Michael; Merion, Robert M.

doi:10.1001/jama.2007.50

Cited by 211 publications

(216 citation statements)

References 29 publications

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“…One study using data from the Organ Procurement and Transplantation Network supported these concerns because rural patients appeared to receive solid organ transplants (including kidney) at modestly lower rates compared with an urban population (10). These findings came into question when a subsequent study using data from USRDS and the United Network for Organ Sharing concluded the contrary: that rural patients who ultimately receive dialysis therapy receive kidney transplants at similar rates or perhaps higher rates than urban patients (11).…”

Section: Discussionmentioning

confidence: 99%

Rural and Micropolitan Residence and Mortality in Patients on Dialysis

Maripuri

Arbogast

İkizler

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Micropolitan and rural patients face challenges when initiating dialysis, including healthcare access. Previous studies have shown little association of nonurban residence with dialysis outcomes but have not examined the association of dialysis modality with residence location.Design, setting, participants, & measurements This retrospective cohort study used data from the U.S. Renal Data System. Adults who initiated maintenance dialysis between January 1, 2006, and December 31, 2007, were classified as rural, micropolitan, or urban. Early and long-term mortality and kidney transplantation were examined with Cox regression stratified by dialysis modality.Results Of 204,463 patients, 80% were urban; 10.2%, micropolitan; and 9.8%, rural. Micropolitan and rural patients were older, were less racially diverse, had more comorbid conditions, and were more likely to start peritoneal dialysis (PD). Median follow-up was 2.0 years. Early mortality or long-term hemodialysis (HD) mortality did not significantly differ by geographic residence. After adjustment, micropolitan and rural PD patients had higher risk for long-term mortality (hazard ratio [HR] Conclusions Micropolitan and rural residence is associated with higher mortality in PD patients and similar or higher likelihood of kidney transplantation among HD and PD patients. Studies examining the underlying mechanisms of these associations are warranted.

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Section: Discussionmentioning

confidence: 99%

Rural and Micropolitan Residence and Mortality in Patients on Dialysis

Maripuri

Arbogast

İkizler

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…Patients living in rural areas and smaller towns have lower wait-listing and transplantation rates than those in urban areas (63). With transplant centers predominately located in more urban areas, exposure to the advantages of transplantation may be lower for rural patients.…”

Section: Ldkt Education and Outreach Should Be Improved For Kidney Pamentioning

confidence: 99%

Living Donor Kidney Transplantation

Waterman¹,

Morgievich²,

Cohen³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Living donor kidney transplantation (LDKT) offers better quality of life and clinical outcomes, including patient survival, compared with remaining on dialysis or receiving a deceased donor kidney transplant. Although LDKT education within transplant centers for both potential recipients and living donors is very important, outreach and education to kidney patients in settings other than transplant centers and to the general public is also critical to increase access to this highly beneficial treatment. In June 2014, the American Society of Transplantation's Live Donor Community of Practice, with the support of 10 additional sponsors, convened a consensus conference to determine best practices in LDKT, including a workgroup focused on developing a set of recommendations for optimizing outreach and LDKT education outside of transplant centers. Members of this workgroup performed a structured literature review, conducted teleconference meetings, and met in person at the 2-day conference. Their efforts resulted in consensus around the following recommendations. First, preemptive transplantation should be promoted through increased LDKT education by primary care physicians and community nephrologists. Second, dialysis providers should be trained to educate their own patients about LDKT and deceased donor kidney transplantation. Third, partnerships between community organizations, organ procurement organizations, religious organizations, and transplant centers should be fostered to support transplantation. Fourth, use of technology should be improved or expanded to better educate kidney patients and their support networks. Fifth, LDKT education and outreach should be improved for kidney patients in rural areas. Finally, a consensus-driven, evidencebased public message about LDKT should be developed. Discussion of the effect and potential for implementation around each recommendation is featured, particularly regarding reducing racial and socioeconomic disparities in access to LDKT. To accomplish these recommendations, the entire community of professionals and organizations serving kidney patients must work collaboratively toward ensuring accurate, comprehensive, and up-to-date LDKT education for all patients, thereby reducing barriers to LDKT access and increasing LDKT rates.

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“…Finally, to account for known and unknown geographical factors that may affect the likelihood of living donation, our analyses were clustered by state of residence and were adjusted by the rural-urban commuting area (RUCA) code. 33,34 RUCA codes are assigned to each US zip code based on markers of population density and were classified into the following groups: metropolitan (cities with a population of .50,000 and their associated suburban areas; RUCA, 1.0-3.9); micropolitan (towns or cities with a population of 10,000-50,000; RUCA, 4.0-6.0); and rural (towns with a population of ,10,000; RUCA, .6.0). Separate analyses were performed in African-American and white populations.…”

Section: Calculation Of Adjusted Irrs For Lkd By Median Household Incomementioning

confidence: 99%

The Effect of Race and Income on Living Kidney Donation in the United States

Gill

Dong

Rose

et al. 2013

Journal of the American Society of Nephrology

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Studies of racial disparities in access to living donor kidney transplantation focus mainly on patient factors, whereas donor factors remain largely unexamined. Here, data from the US Census Bureau were combined with data on all African-American and white living kidney donors in the United States who were registered in the United Network for Organ Sharing (UNOS) between 1998 and 2010 (N=57,896) to examine the associations between living kidney donation (LKD) and donor median household income and race. The relative incidence of LKD was determined in zip code quintiles ranked by median household income after adjustment for age, sex, ESRD rate, and geography. The incidence of LKD was greater in higher-income quintiles in both African-American and white populations. Notably, the total incidence of LKD was higher in the African-American population than in the white population (incidence rate ratio [IRR], 1.20; 95% confidence interval [95% CI], 1.17 to 1.24]), but ratios varied by income. The incidence of LKD was lower in the African-American population than in the white population in the lowest income quintile (IRR, 0.84; 95% CI, 0.78 to 0.90), but higher in the African-American population in the three highest income quintiles, with IRRs of 1.31 (95% CI, 1.22 to 1.41) in Q3, 1.50 (95% CI, 1.39 to 1.62) in Q4, and 1.87 (95% CI, 1.73 to 2.02) in Q5. Thus, these data suggest that racial disparities in access to living donor transplantation are likely due to socioeconomic factors rather than cultural differences in the acceptance of LKD.

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Rates of Solid-Organ Wait-listing, Transplantation, and Survival Among Residents of Rural and Urban Areas

Cited by 211 publications

References 29 publications

Rural and Micropolitan Residence and Mortality in Patients on Dialysis

Rural and Micropolitan Residence and Mortality in Patients on Dialysis

Living Donor Kidney Transplantation

The Effect of Race and Income on Living Kidney Donation in the United States

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