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Kidney Week

Abstract: TH-PO897

Higher Dialysis Facility Patient-to-Nurse Staffing Ratio Is Associated with Lower Hazard of Kidney Transplantation Among Adolescents and Young Adults

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical

Authors

  • Bicki, Alexandra, University of California San Francisco, San Francisco, California, United States
  • Mcculloch, Charles E., University of California San Francisco, San Francisco, California, United States
  • Grimes, Barbara A., University of California San Francisco, San Francisco, California, United States
  • Ku, Elaine, University of California San Francisco, San Francisco, California, United States
Background

Higher patient-to-nurse ratios at dialysis facilities have been associated with worse patient outcomes in older adults. We aimed to examine if this nurse staffing ratio is associated with access to kidney transplant in children and young adults.

Methods

This is a retrospective analysis of the US Renal Data System, of patients 12-30 years who initiated dialysis from 2005-2019 at US dialysis facilities. Cox models were used to relate the primary exposure (patient-to-nurse ratio at the dialysis facility) to receipt of kidney transplant (either living or deceased donor).

Results

51,419 individuals were included (74% were ≥22 years, 84% initiated with hemodialysis). Median staffing ratio was 14 patients per 1 nurse (IQR 10:1 to 19:1). Over a median follow-up time of 2.4 years, 53% of those <22 years vs. 34% of those ≥22 years received a kidney transplant. In adjusted analysis, each doubling of the patient-to-nurse ratio at a facility resulted in 15% lower hazard of transplantation (HR 0.85; 95% CI: 0.84-0.87). There was an interaction (p<0.001) by age at dialysis initiation, such that the association between higher patient:nurse ratio and access to transplantation was more pronounced in those 12-21 years (HR 0.79, 95% CI: 0.77-0.82) vs. 22-30 years (HR 0.96, 95% CI: 0.94-0.99).

Conclusion

Adolescents and young adults receiving care from facilities with higher patient-to-nurse ratio had lower hazard of transplantation compared to those receiving care facilities with lower staffing ratios. Low dialysis nurse staffing ratios may represent a crucial facility characteristic that promotes successful kidney transplantation, particularly for adolescents.

Funding

  • NIDDK Support