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Abstract: PO2488

Lower Prevalence of Kidney Transplant Waitlisting in Micropolitan Areas, Small Towns, and Rural Areas

Session Information

Category: Transplantation

  • 1901 Transplantation: Basic


  • Weinhandl, Eric D., Fresenius Medical Care, Waltham, MA, Anguilla
  • Hamilton, H. Emel, Fresenius Medical Care, Waltham, MA, Anguilla
  • Dalrymple, Lorien S., Fresenius Medical Care, Waltham, MA, Anguilla

The Percentage of Prevalent Patients Waitlisted (PPPW) measures the percentage of patients at a dialysis facility who were on the kidney or kidney-pancreas transplant waitlist. This measure joined the End Stage Renal Disease Quality Incentive Program in performance year 2020, with a weight of 4%. PPPW is adjusted for age, but not for other factors. Physical distance between residence and transplant center may influence PPPW. As an indirect test of this hypothesis, we assessed whether PPPW was associated with rural-urban commuting area (RUCA) levels.


We analyzed data in Dialysis Facility Compare (DFC), as of October 30, 2019. DFC included PPPW values that quantified waitlisting prevalence during 2018. According to ZIP code, we classified the location of each dialysis facility as metropolitan (RUCA values, 1-3), micropolitan (4-6), small town (7-9), or rural (10). We estimated weighted mean PPPW values in each location class, with the weight of each facility equal to the number of patients contributing to PPPW. We fit a linear regression model to test differences in PPPW values between the location classes.


PPPW values were reported in 7086 (94%) of 7566 dialysis facilities, and RUCA values were identified in 6999 (99%) of 7086 facilities. The weighted mean PPPW value among all facilities was 17.5%. There were 5363 (77%) facilities in metropolitan areas, 954 (14%) in micropolitan areas, 550 (8%) in small towns, and 132 (2%) in rural areas. By location class, weighted mean PPPW values were 18.5% in metropolitan areas, 12.8% in micropolitan areas, 12.1% in small towns, and 10.8% in rural areas. Relative to the mean PPPW value in metropolitan areas, mean PPPW values were 5.8, 6.5, and 7.7 percentage points lower in micropolitan areas, small towns, and rural areas, respectively (P < 0.01 for each).


The PPPW measure takes significantly lower values in dialysis facilities located in micropolitan areas, small towns, and rural areas, relative to metropolitan areas. The physical distance between residence and transplant center may preclude many patients in non-metropolitan areas from completing the process of kidney transplant evaluation. New processes are needed to improve access to transplantation in outlying areas.


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