Abstract: SA-PO044
Transplantation for Veterans Receiving Dialysis in VA and Non-VA Settings
Session Information
- Transplantation: Clinical Outcomes
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Wang, Virginia, Durham VA HCS, Durham, North Carolina, United States
- Coffman, Cynthia, Durham VA HCS, Durham, North Carolina, United States
- Stechuchak, Karen M., Durham VA HCS, Durham, North Carolina, United States
- Hebert, Paul, VA Puget Sound HCS, Seattle, Washington, United States
- O'Hare, Ann M., VA Puget Sound HCS, Seattle, Washington, United States
- Edelman, David, Durham VA HCS, Durham, North Carolina, United States
- Maciejewski, Matthew L., Durham VA HCS, Durham, North Carolina, United States
Background
Veterans with end-stage renal disease can receive dialysis under a range of different settings and payment structures including Medicare community dialysis, VA, and VA-purchased community-based dialysis (VA-PC). An earlier study reported similar rates of renal transplant among VA and Medicare users but little is known about rates of transplantation among Veterans receiving dialysis in different settings. This study compares receipt of renal transplantation among Veterans across dialysis settings.
Methods
We merged VA and Medicare data to construct a national cohort of VA-enrolled Veterans who initiated chronic dialysis in 2008-2011. Cohort members were classified based on dialysis setting during the 2-year period immediately following dialysis initiation: VA, VA-PC in community, Medicare-financed dialysis in community, or more than one of these arrangements (“Dual settings”). We used a Cox proportional hazards model (censoring at death) to examine associations between 2-year dialysis setting and transplantation, adjusting for patient characteristics.
Results
Of the 27,301 cohort members, 67% received dialysis under Medicare only, 11% received dialysis through VA-PC only, 4% were treated in VA only, and 18% were treated in Dual settings. Roughly 2.5% of Veterans received a kidney transplant within 2 years, in an average 375 days after dialysis start (median=366, IQR=358). In adjusted analyses, Veterans receiving dialysis in VA, VA-PC, and Dual settings had similar transplantation rates that were lower than those under Medicare (HR=0.45, 95% CI= 0.29, 0.72; HR=0.49, 95% CI=0.35, 0.68; and HR=0.57, 95% CI=0.43, 0.76, respectively). Estimated 2-year transplant rates are shown in Fig 1.
Conclusion
Rates of renal transplant are lower among Veterans who receive any VA-financed dialysis than for those receiving Medicare-financed dialysis. More work is needed to identify barriers to kidney transplant among Veterans whose dialysis is financed by the VA.
Fig 1. Estimated 2-year transplantation rates, by dialysis setting
Funding
- Veterans Affairs Support