Abstract: SA-OR072

Association of Dialysis Facility Ownership on Access to Kidney Transplant Waitlist or Living Donor Transplant

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Gander, Jennifer C., Emory University, Atlanta, Georgia, United States
  • Ross, Katherine, Emory University, Atlanta, Georgia, United States
  • Mohan, Sumit, Columbia University, New York, New York, United States
  • Pastan, Stephen O., Emory University School of Medicine, Atlanta, Georgia, United States
  • Patzer, Rachel E., Emory Transplant Center, Atlanta, Georgia, United States
Background

Past studies have shown for-profit facilities have lower rates of kidney transplantation (KT), but used older data that did not account for differences in facility ownership. Our aim was to examine the relationship between dialysis facility ownership and access to KT.

Methods

We linked adult, incident ESRD, United States Renal Data System (2000-2014) patient data with facility ownership (Dialysis Facility Compare) and facility-level characteristics (Dialysis Facility Report). Access to KT was defined as incident waitlisting or receipt of living donor KT. Facility ownership was categorized into one of five groups as either for-profit, large company (Groups A and B), for-profit small clinics(Group C), for-profit independent clinics (Group D), or non-for profit clinics (Group E). Hierarchical survival analysis assessed the association between access to KT and dialysis facility ownership while controlling for patient- and facility-level characteristics and patient-level clustering.

Results

Among 1,137,113 patients in our study cohort, 166,240 (14.6%) were waitlisted or received a living donor KT and among 6,263 U.S. facilities. In adjusted survival analysis, patients waitlisted or receiving a living donor KT were more likely to be Hispanic (HR=1.45; 95% CI 1.40, 1.51) and male (HR=1.39; 95% CI 1.33, 1.46), and less likely to have heart disease (HR=0.46; 95% CI 0.46, 0.47), and Medicaid insurance (HR=0.44; 95% CI 0.43, 0.45). ESRD patients receiving treatment from Group A and Group B facilities were less likely (HR=0.59; 95% CI 0.53, 0.66 and HR=0.57; 95% CI 0.51, 0.64; respectively) to be waitlisted or receive a living donor KT compared to non-profit facilities (Figure 1).

Conclusion

Dialysis facility ownership was found to be significantly associated with a patient’s access to KT. Facilities can influence their patients’ access to the KT waitlist and living donor KT. We urge CMS to adopt quality measures that hold dialysis facilities accountable for patient access to KT.

Funding

  • NIDDK Support