1. Variation in Access to Kidney Transplantation Across Renal Programs in Ontario, Canada.
- Author
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Naylor KL, Dixon SN, Garg AX, Kim SJ, Blake PG, Nesrallah GE, McCallum MK, D'Antonio C, Li AH, and Knoll GA
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Glomerular Filtration Rate, Humans, Kidney Function Tests, Male, Middle Aged, Ontario, Prognosis, Retrospective Studies, Risk Factors, Young Adult, Health Services Accessibility statistics & numerical data, Kidney Failure, Chronic surgery, Kidney Transplantation methods, Registries statistics & numerical data, Renal Dialysis
- Abstract
In the United States, kidney transplant rates vary significantly across end-stage renal disease (ESRD) networks. We conducted a population-based cohort study to determine whether there was variability in kidney transplant rates across renal programs in a health care system distinct from the United States. We included incident chronic dialysis patients in Ontario, Canada, from 2003 to 2013 and determined the 1-, 5-, and 10-year cumulative incidence of kidney transplantation in 27 regional renal programs (similar to U.S. ESRD networks). We also assessed the cumulative incidence of kidney transplant for "healthy" dialysis patients (aged 18-50 years without diabetes, coronary disease, or malignancy). We calculated standardized transplant ratios (STRs) using a Cox proportional hazards model, adjusting for patient characteristics (maximum possible follow-up of 11 years). Among 23 022 chronic dialysis patients, the 10-year cumulative incidence of kidney transplantation ranged from 7.4% (95% confidence interval [CI] 4.8-10.7%) to 31.4% (95% CI 16.5-47.5%) across renal programs. Similar variability was observed in our healthy cohort. STRs ranged from 0.3 (95% CI 0.2-0.5) to 1.5 (95% CI 1.4-1.7) across renal programs. There was significant variation in kidney transplant rates across Ontario renal programs despite patients having access to the same publicly funded health care system., (© 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.)
- Published
- 2017
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