Kidney Week

Abstract: PUB500

International Survey of Nephrologists about Referral of Patients with Advanced CKD for Kidney Transplantation

Session Information

• Publication Only

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Zahran, Somaya, McGill University, Montreal, Quebec, Canada

Somaya Zahran, MD, PhD

• Sandal, Shaifali, McGill University, Montreal, Quebec, Canada

Shaifali Sandal, MD

• Malyszko, Jolanta, Uniwersytet w Bialymstoku, Bialystok, Poland

Jolanta Malyszko, MD, PhD, FASN

• Basu, Gopal, The Alfred, Melbourne, Victoria, Australia

Gopal Basu, MD, MBBS, FASN

• Ghnaimat, Mohd, The Specialty Hospital, Amman, Amman, Jordan

Mohd Ghnaimat, MD, PhD

• Castro, Maria cristina R., Universidade de Sao Paulo, Sao Paulo, Brazil

Maria cristina R. Castro, MD

• Jha, Vivekanand, The George Institute for Global Health, Delhi, India

Vivekanand Jha, MD

• Cantarovich, Marcelo, McGill University, Montreal, Quebec, Canada

Marcelo Cantarovich, MD

Group or Team Name

• ISN-TTS Working Group on Referral for Kidney Transplantation.

Background

Kidney transplantation (KTx) is the treatment of choice for patients with kidney failure and could be lifesaving in countries with limited access to dialysis. However, studies have shown low rates of referrals from high-income countries (HIC);17-33% within the first year of chronic dialysis initiation, while data is lacking in low-income countries (LIC).

Methods

An ISN-TTS working group created a Knowledge, Attitude and Practice (KAP) survey, sent to nephrologists globally via the ISN mailing list. Responses are collected anonymously and sorted per respondents’ countries income level. HIC and middle-high were combined into HIC and LIC and middle-low were combined into LIC. The survey is currently being administered. We report preliminary analysis of the first 100 responses to 9 compiled questions across KAP pillars.

Results

Respondents from 55 countries are 62% males, 60% 30-50 years, and 85% work at academic centers. Living and/or deceased donor KTx is available in 92.5% and HIC comprise 52%. Knowledge questions were answered similarly in both cohorts, except for referral of elderly patients (P=0.01), patients with nonadherence (P=0.014), or financial hurdles (P=0.027). Responses to attitude questions are shown in Fig 1. Based on participants’ practice, patients in LIC vs. HIC were referred as follows: elderly <15% vs. 45% (P<0.0001), preemptively 70% vs. 90% (P<0.004), combined Tx 8% vs. 30% (P=0.0002); patients with cancer in remission 25% vs. 55% (P=0.007); financial difficulties 22% vs. 65% (P<0.0001).

Conclusion

Our results highlight KTx referral pattern differences between LIC and HIC. Educational activities should address practitioners’ needs and optimize KTx referral for patients worldwide.

Case scenario questions, responses are based on comfort level (Likert scale:1 uncomfortable–5 very comfortable)