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Kidney Week

Abstract: SA-PO965

Kidney Transplantation Outcomes by Dialysis Modality in an Underserved Population

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical

Authors

  • Huzair, Ali, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Patel, Jiten, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Ganguly, Anisha, Parkland Health, Dallas, Texas, United States
  • Sian, Jaspreet, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Smartt, Jillian L., Parkland Health, Dallas, Texas, United States
  • Harms, Michael, Parkland Health, Dallas, Texas, United States
  • Saxena, Ramesh, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
Background

While in-center hemodialysis (HD) is delivered by trained healthcare providers, peritoneal dialysis (PD) involves active patient-engagement in dialysis treatment. This process of self-care can be associated with a range of potential collateral health benefits that can positively impact clinical and patient-centered outcomes. Kidney transplantation (KT) is the major outcome goal among kidney failure (KF) patients who initiate dialysis. Several studies have shown that PD patients are more likely to receive KT, compared to HD patients. However, baseline differences among HD and PD patient populations such as age, race/ethnicity, education and socioeconomic status, may confound differences in receipt of KT. In this retrospective study, we compared transplant evaluation and listing status among propensity matched incident HD and PD patients initiating dialysis at Parkland Health, a safety net health system caring for underserved populations in Dallas County.

Methods

We included adult patients, who were newly initiated on HD or PD at Parkland Health from January 2012 to December 2022. PD Patients were propensity matched 1:1 with HD patients based on language, race/ethnicity, age and comorbidities. The primary outcome was proportion of patients evaluated for transplantation, while key secondary outcomes included proportion of patients listed for transplantation, reasons for not listing, and proportion transplanted.

Results

During the study period 155 patients were initiated on PD, and were matched with 155 patients initiating on HD. Of patients initiated on PD, 133 (85.8%) were evaluated for KT, compared to 109 (70.3%) patients on HD (p=0.001). Eventually, 78 (50.3%) PD patients and 50 (35.5%) HD patients were listed for transplantation (p=0.001). Of the patients evaluated but not listed, medical ineligibility was the predominant reason in PD group (38/54, 70.3%), while in HD group 36/56 (65%) were not listed due to lack of interest and non-adherence to treatment. Finally, 27 HD patients and 33 PD patients underwent KT (p=0.108).

Conclusion

We observed that more PD patients presented for transplant evaluation compared to HD individuals in a safety net system. This led to higher KT listing of PD versus HD patients. These findings suggest that patient engagement through PD may improve distal KF outcomes, including KT, among underserved population.