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Abstract: SA-PO372

Pediatric Nephrology Workforce in the United States and Access to Waitlist Registration in Children with ESKD

Session Information

  • Pediatric Nephrology - III
    November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Accetta Rojas, Gabriela, University of California San Francisco, San Francisco, California, United States
  • Mcculloch, Charles E., University of California San Francisco, San Francisco, California, United States
  • Whelan, Adrian, University of California San Francisco, San Francisco, California, United States
  • Copeland, Timothy P., University of California San Francisco, San Francisco, California, United States
  • Bicki, Alexandra, University of California San Francisco, San Francisco, California, United States
  • Giang, Sophia, 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

Nephrology is one of the pediatric subspecialties with the lowest workforce density in the US with minimal improvements noted over the last two decades. Pediatric nephrologists (PN) are critical partners in preparing children for kidney transplantation (KT), which is the preferred treatment modality. We hypothesized that geographic variations in the density of PN could associate with variations in the time to waitlist registration and living donor kidney transplantation (LDKT).

Methods

Retrospective cohort study of children <18 years who developed ESKD between 2016 to 2019 according to the United States Renal Data System. The number of active PN per state was estimated by the American Board of Pediatrics (ABP) in 2022 and state population <18 years was estimated by US Census Bureau Population Estimates in 2021.We examined the association between density of PN per 100,000 children and time to waitlist registration and LDKT using Cox models. Odds of preemptive waitlisting was examined using logistic regression models. All models used cluster (state) robust standard errors.

Results

We included 3,442 children, of whom 2,319 (67.4%) were waitlisted for kidney transplantation. The median density of PN/100,000 children/state was 0.85 (IQR 0.56 -1.19 (see Figure). The median time to waitlist registration was 0.65 years (IQR 0.32-1.16). Children residing in states with > 1 PN/100,000 had a 64% better access to waitlisting (HR:1.64, 95% CI 1.41-1.90); 2.8 times higher odds of preemptive waitlisting (OR:2.80, 95%CI 1.66-4.72) compared with children residing in states with < 0.4 PN/100,000; and 2.31 higher hazard of LDKT (HR: 2.31, 95% CI 1.40-3.82).

Conclusion

Lower density of pediatric nephrologists is associated with worse access to waitlist registration. Further studies to examine the implications of workforce availability and care of children with kidney disease are warranted.

Funding

  • NIDDK Support