ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2022 and some content may be unavailable. To unlock all content for 2022, please visit the archives.

Abstract: FR-PO875

Variation in Kidney Failure Risk in Preemptively Listed Patients for Kidney Transplantation

Session Information

Category: Diversity and Equity in Kidney Health

  • 800 Diversity and Equity in Kidney Health

Authors

  • Hirsch, Jamie S., Northwell Health, New Hyde Park, New York, United States
  • Abate, Mersema, Northwell Health, New Hyde Park, New York, United States
  • Jhaveri, Kenar D., Northwell Health, New Hyde Park, New York, United States
  • Nair, Vinay, Northwell Health, New Hyde Park, New York, United States
Background

ESKD progression depends on several factors, therefore a static eGFR cut-off for listing may lead to disparities. The Kidney Failure Risk Equation (KFRE) is a validated score to calculate 2 & 5 yr ESKD risk. We applied KFRE to pts in our pre-emptively listed KT candidates and reviewed transplantation rate.

Methods

Adult pts listed pre-emptively between 1/1/12 and 12/31/21 with follow-up through 2/18/22. GFR calculated using 2009 CKD-EPI equation (race coefficient; eGFRcr2009), 2021 CKD-EPI equation (race-free; eGFRcr2021), and universal eGFR of 20ml/min for comparisons of risk within and between races. Incidence of KT was examined.

Results

Of 279 patients, median age- 57 (IQR 46, 65), 173 (62%) male, 115 (41%) White, 61 (22%) Black, 64 (23%) Asian, and 39 (14%) Hispanic. Median eGFRcr2009 was 14.1 (IQR 10.7-16.9) and eGFRcr2021 was 14.5 (IQR 10.8-17.5); median Ur alb/crt ratio was 1286 (IQR 426-2480), and the 2-& 5-yr ESKD risk was 64% (IQR 41-83) and 96% (IQR 81-100), respectively. White patients were listed at higher median eGFRcr2009 and this discrepancy was exacerbated, and most pronounced for Black patients, with eGFRcr2021. 2 year KFRE risk was higher for all races regardless of eGFR formula used (eGFRcr2009, eGFRcr2021, eGFR 20ml/min) as compared with Whites. Figure 1A shows wide variability within races. At last follow-up, 45 White (39%), 23 Asian (36%), 15 Black (25%) and 12 Hispanic (31%) had pre-emptive KT. Black patients had a longer follow-up time without KT and had a lower cumulative incidence of successful KT within 2 years of listing (Figure 1B).

Conclusion

Pre-emptively listed KT candidates had a wide variation in 2-yr ESKD risk by KFRE. Risk was lowest in White patients and Black patients had the lowest incidence of KT.

(A) Distribution of 2-year KFRE risk, by race/ethnicity. (B) Cumulative incidence of pre-emptive transplant at 2 years of follow up.