Abstract: TH-PO1212
Perspectives on Using Hyperphosphatemia (HPhos) and Medication Nonadherence (Med NA) to Assess Transplant Readiness in Children with CKD
Session Information
- Pediatric Nephrology: CV Health, CKD, AKI, Dialysis, Transplantation, and Health Services Research
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1800 Pediatric Nephrology
Authors
- Pottanat, Neha D., Indiana University School of Medicine, Indianapolis, Indiana, United States
- Oh, Gia J., University of California Davis, Davis, California, United States
- Laster, Marciana, Indiana University School of Medicine, Indianapolis, Indiana, United States
Background
In pediatric CKD, uncontrolled HPhos is interpreted as a surrogate for treatment NA and transplant readiness. However, phosphorus is influenced by biologic variability, dialysis adequacy, nutrition, socioeconomic barriers, and treatment burden, raising concerns about the validity and equity of its use to restrict transplant referral and listing. We examined clinician perspectives on how HPhos and med NA influence transplant referral, listing, and activation decisions.
Methods
61 referring and transplant providers from 39 centers in the Pediatric Nephrology Research Consortium were surveyed. Open-ended responses underwent rapid thematic analysis by independent reviewers to develop conceptual frameworks.
Results
HPhos was infrequently cited as a barrier to referral or inactive listing (26–29%) but was more often considered when determining active listing (44%). Half of clinicians viewed HPhos as a marker of NA and rejection risk, yet most reported no formal policy. In contrast, med NA was viewed as more directly actionable: 55% reported it influenced referral decisions and 87% cited it as a sole reason to defer activation. Although >90% agreed medication NA increases rejection risk, <15% reported use of a standardized pre transplant adherence metric. Clinicians viewed HPhos as a multifactorial measure influenced by clinical and social determinants and favored cautious, contextual interpretation within multidisciplinary assessment (Fig 1). Med NA was also viewed as multifactorial but potentially modifiable through supportive interventions and more appropriate to inform timing of listing or activation rather than restrict referral.
Conclusion
Clinician approaches to incorporating HPhos and medication NA into transplant readiness assessment vary. While HPhos is sometimes used as a surrogate marker of NA, most clinicians recognize its limitations and favor individualized interpretation. Standardized, equitable approaches to pre transplant adherence assessment are needed.