Geographic Variation in End-Stage Renal Disease Incidence and Access to Deceased Donor Kidney Transplantation

Background

• End-Stage Renal Disease (ESRD):
  • A debilitating condition with high morbidity and mortality.
  • Rapidly increasing incidence and prevalence in the US.
• Kidney Transplantation:
  • Provides survival benefits and quality of life improvements.
  • Significant growth in the number of candidates waiting for transplantation.

Study Objective

• To assess the effect of ESRD incidence on access to the kidney waiting list and deceased donor kidney transplantation.
• Evaluate geographic variations in access to kidney transplantation.

Data and Methods

• Data Sources:
  • U.S. Census Bureau, Centers for Medicare & Medicaid Services (CMS), OPTN/SRTR from 2000 to 2008.
• Analysis Levels:
  • Donation Service Area (DSA) and patient-level analyses.
• Factors Considered:
  • Organ demand (ESRD incidence) and organ supply (donation rates).
• Regression Models:
  • Multivariable regression to assess wait-list and transplant rates.

Key Findings

• ESRD and Transplantation Trends (2000-2008):
  • ESRD cases increased by 16.2%.
  • Waiting list grew by 48.9%.
  • Transplant population grew by 30.1%.
• Geographic Variation:
  • Significant variation in ESRD incidence and donation rates across DSAs.
  • High ESRD areas showed lower transplant rates.
• Effect of ESRD Incidence:
  • High ESRD incidence associated with lower wait-list and transplant rates, even after adjusting for donation rates.
  • Increased wait times and perception of resource saturation in high ESRD areas.

Factors Affecting Access to Transplantation

• Organ Supply and Demand:
  • High donation rates associated with higher transplant rates.
  • High ESRD demand correlates with higher organ discard rates and use of expanded criteria donors (ECD).
• Patient and Provider Factors:
  • Racial disparities in access to transplantation; African Americans and Native Americans have less access compared to whites and Asians.
  • Factors such as patient demographics, OPO competition, and organ acceptance practices influence access.

Implications and Recommendations

• Policy Implications:
  • Need for policies to address geographic disparities in transplant access.
  • Consider adjustments in kidney allocation policies to address inequities.
  • Potential for improving equity through increased organ sharing with high ESRD areas.
• Research and Development:
  • Further exploration of how ESRD incidence affects local transplant practices.
  • Evaluate the impact of policy changes on access to transplantation.

Conclusion

• Geographic variation in ESRD incidence significantly affects access to kidney transplantation.
• High ESRD incidence areas face challenges in accessing transplant services, highlighting the need for strategic interventions and policy reforms.

Conflict of Interest

• Authors declare no conflicts of interest.

References

• Provided extensive references to previous studies and data sources.