Abstract: FR-PO1034

Referral Rates for Renal Transplant in Dialysis Clinic, Inc.

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Harford, Antonia, UNM, Albuquerque, New Mexico, United States
  • Paine, S., DCI, Albuquerque, New Mexico, United States
  • Schrader, R., DCI, Albuquerque, New Mexico, United States
  • Gul, Ambreen, DCI, Albuquerque, New Mexico, United States
  • Zager, Philip, UNM, Albuquerque, New Mexico, United States
Background

Kidney transplantation (TXP) is the treatment of choice for medically appropriate End-Stage Renal Disease (ESRD) patients. Dialysis facilities play pivotal roles in (1) referring ESRD patients for the initial TXP evaluation; (2) assisting in the evaluation process; and (3) listing. Renal transplantation rates reflect significant racial disparity. Among ESRD patients incident in the US in 2011, overall the percent waitlisted or transplanted (WL/TXP) within 3 years was 13.7% but varied greatly by race, highest among Asians (32.7%) & lowest among Native Americans/Alaskan Native (11.1%). Dialysis Clinic, Inc. (DCI), a large not-for-profit provider, founded by a transplant nephrologist, is developing an innovative education program to enhance referral, WL/TXP & reduce health disparities.

Methods

The present study was conducted to obtain baseline data that will facilitate future annual assessments of the impact of this program. We studied 2,677 dialysis patients under age 70 who began dialysis in 2015, in 230 facilities operated by DCI. We used DCI’s MIS to calculate referral, WL/TXP, & refusal rates, stratified by race, sex & diabetes status within the first year of dialysis.

Results

Overall, the referral rate was 62.6; 19.0% were WL/TXP, 43.6% were referred but not yet WL/TXP, 18.4% refused referral, & 28.3% were not referred. The rates, expressed per 100 patient years (95% CI), for referrals, not referred, WL/TXP & refusals, stratified by race, diabetes status, & sex are shown. There were no significant differences in referral or refusal rates across racial groups. Referral & refusal rates, respectively, did not differ significantly by race, sex or diabetes status. However, the point estimates for WL/TXP were lower in Blacks & Native Americans vs. Whites & in diabetics vs. non-diabetics.

Conclusion

Excellence in patient & staff education is essential to maximize transplant referral, WL/TXP, and minimize TXP related disparities. To accomplish these objectives innovative educational programs need to be developed & implemented for both dialysis facility staff & patients across the full-range of providers.