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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.