Kidney Week

Abstract: SA-PO962

Disparities in Access to Upstream Steps in the Kidney Transplant Pathway among Young Adults with New-Onset Kidney Failure

Session Information

• Transplantation: Clinical - 3
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Drewry, Kelsey M., Indiana University School of Medicine, Indianapolis, Indiana, United States

Kelsey M. Drewry, MA, PhD

• Buford, Jade, Regenstrief Institute Inc, Indianapolis, Indiana, United States

Jade Buford, MPH

• Ayuk-Arrey, Arrey-Takor, Regenstrief Institute Inc, Indianapolis, Indiana, United States

Arrey-Takor Ayuk-Arrey

• Parulekar, Jaya S., Indiana University School of Medicine, Indianapolis, Indiana, United States

Jaya S. Parulekar, MD

• Laster, Marciana, Indiana University School of Medicine, Indianapolis, Indiana, United States

Marciana Laster, MD, MS

• Patzer, Rachel E., Regenstrief Institute Inc, Indianapolis, Indiana, United States

Rachel E. Patzer, PhD, MPH

Background

Despite the benefits of kidney transplantation compared to dialysis, access to transplant remains limited, especially among marginalized populations. Inequities in access to the transplant waitlist persist even among young, otherwise healthy patients with kidney failure who may be best suited for transplant. This study used the only multi-regional referral data to assess whether disparities in access to waitlisting among young patients arise from inequitable access to the pre-waitlisting steps of referral for transplant and evaluation initiation.

Methods

Young adults (age 18-40 years) with new-onset kidney failure in Georgia, North Carolina, and South Carolina (2015-2020) were identified using the United States Renal Data System. Primary outcomes included timely referral for evaluation (within one year of dialysis initiation) and evaluation initiation (within three months of referral among all referred patients), assessed via linkage to the Early Steps to Transplant Access Registry. The odds of timely referral and evaluation were compared using multivariable logistic regression.

Results

Among 13,291 patients (mean [SD] age: 33 [6]; 7528 [57%] male; 1756 [13%] Hispanic, 6535 [49%] Black), 6374 [48%] were referred for evaluation within 1 year of dialysis initiation, and 5448 [41%] began the evaluation within 3 months of referral. In adjusted logistic regression models, White race, full time employment, private health insurance, and longer durations of pre-kidney failure nephrology care were positively associated with timely referral and evaluation. Hispanic ethnicity was associated with lower odds of referral (aOR 0.57 [95% CI 0.49-0.68]), but not evaluation start (aOR 0.80 [95% CI 0.58-1.10]).

Conclusion

This retrospective cohort study found racial, ethnic, and socioeconomic inequities in access to timely referral and evaluation for kidney transplant among young patients likely to be highly suitable for transplant. To improve equity in access to transplantation and subsequent outcomes in this key age group, interventions should focus on increasing the proportion of young patients from underserved populations who are referred for transplant evaluation within the first year of kidney failure diagnosis, and ensuring referred individuals progress to initiating the evaluation.

Funding

• NIDDK Support