Variation between centres in access to renal transplantation in UK: longitudinal cohort study

Abstract

Objective To assess whether equity exists in access to renal transplantation in the UK after adjustment for case mix in incident patients with end stage renal disease. Design Longitudinal cohort study. Setting UK Renal Registry and UK Transplant Registry. Participants All incident renal replacement treatment patients (n=16 202) from 65 renal centres submitting data

Individual and Regional Factors of Access to the Renal Transplant Waiting List in France in a Cohort of Dialyzed Patients

“…Our study also confirms previous results about the association between old age and poor access to the waiting list, reported in Lorraine (23) and in other countries (19,25,26,29,30). Compared to patients aged l8-39 years, those older than 70 years were 97.5% less likely to be placed on the waiting list, after adjustment for other patient-level and region-level factors.…”

“…Compared to polycystic kidney disease, diabetic nephropathy was associated with a lower probability of waiting-list placement, as other reports have shown (19,25,26,30). As the consistency of these findings with the studies cited above indicates, the associations for these patient-level factors are likely to be generally applicable, in France and elsewhere.…”

“…Several studies have shown that selection criteria for potential kidney transplant candidates vary significantly between countries and also between centers in the same country (18)(19)(20)(21)(22). Similarly, a wide variety of patient-level factors have been associated with access to renal transplant waiting lists, including not only medical factors (diabetes, cardiovascular disease and other comorbidities, and causes of ESRD), but also nonmedical factors such as gender and race/ethnicity (23)(24)(25)(26)(27)(28)(29)(30)(31).…”

Chronic kidney disease, albuminuria and socioeconomic status in the Health Surveys for England 2009 and 2010

“…Non-response weights were used in all analyses. Despite low numbers from ethnic minorities, ethnicity is associated with variation in RRT rates, 13,14 and ethnicity was therefore included as a potential confounder in multivariable analyses. Three dichotomized-dependent variables were investigated: CKD defined by the CKDEPI equation as eGFR ,60 ml/min/1.73 m 2 (Stage 3 -5); the presence of micro-or macro-albuminuria and CKD stage 1 -2 defined as eGFR .60 ml/min/1.73 m 2 with evidence of albuminuria.…”

The UK Renal Research Strategy

“…• Pinpointing inequalities in access to kidney transplantation 80 • Assessing patient attitudes towards transplant listing: the ATTOM study 81 • Obesity and kidney transplantation and the role of nutritional intervention in kidney transplant outcomes 82 • A UK Renal Registry analysis exploring the relationship between socio-economic status, ethnicity and access to living donor kidney transplantation 83 • Predicting recurrence of kidney disease after transplantation 84 • Working out the best drugs to prevent rejection of renal transplants: the 3C study 85 …”