Dialysis Facility and Network Factors Associated With Low Kidney Transplantation Rates Among United States Dialysis Facilities

• Type of Material: Article
• Authors: Rachel Patzer, Emory University; Laura Plantinga, Emory University; J Krisher, Southeastern Kidney Council of ESRD Network 6, Raleigh; Stephen Pastan, Emory University
• Language: English
• Date: 2014-07-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © Copyright 2014 The American Society of Transplantation and the American Society of Transplant Surgeons.
• Final Published Version (URL): http://dx.doi.org/10.1111/ajt.12749
• Title of Journal or Parent Work: American Journal of Transplantation
• ISSN: 1600-6135
• Volume: 14
• Issue: 7
• Start Page: 1562
• End Page: 1572
• Grant/Funding Information: REP was supported in part by grants from the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number ULl TR000454 and KL2TR000455.; REP and SOP are both supported in part by R24MD008077 through the National Institute on Minority Health and Health Disparities.
• Keywords: POVERTY; ACCESS; Life Sciences & Biomedicine; kidney transplantation; DISEASE; OUTCOMES; SOCIOECONOMIC-STATUS; Transplantation; RENAL-TRANSPLANTATION; RACIAL DISPARITIES; Surgery; ESRD Networks; RACE; QUALITY; HEALTH DISPARITIES; Dialysis facilities; Science & Technology
• Research Categories: Sociology, Public and Social Welfare; Health Sciences, Public Health; Health Sciences, Medicine and Surgery

Abstract

Variability in transplant rates between different dialysis units has been noted, yet little is known about facility-level factors associated with low standardized transplant ratios (STRs) across the United States End-stage Renal Disease (ESRD) Network regions. We analyzed Centers for Medicare & Medicaid Services Dialysis Facility Report data from 2007 to 2010 to examine facility-level factors associated with low STRs using multivariable mixed models. Among 4098 dialysis facilities treating 305 698 patients, there was wide variability in facility-level STRs across the 18 ESRD Networks. Four-year average STRs ranged from 0.69 (95% confidence interval [CI]: 0.64-0.73) in Network 6 (Southeastern Kidney Council) to 1.61 (95% CI: 1.47-1.76) in Network 1 (New England). Factors significantly associated with a lower STR (p-<-0.0001) included for-profit status, facilities with higher percentage black patients, patients with no health insurance and patients with diabetes. A greater number of facility staff, more transplant centers per 10 000 ESRD patients and a higher percentage of patients who were employed or utilized peritoneal dialysis were associated with higher STRs. The lowest performing dialysis facilities were in the Southeastern United States. Understanding the modifiable facility-level factors associated with low transplant rates may inform interventions to improve access to transplantation. Standardized transplant ratios vary widely among the more than 4,000 dialysis facilities in the United States, and facilities with the lowest rates are located in the Southeast. Also see viewpoint by Patzer and Pastan (page 1499) and counterpoint by Srinivas (page 1506).