Analysis of the performance of dialysis centers in referring and enrolling patients into the pre-kidney transplant waiting list in Minas Gerais State, Brazil, 2015 to 2019

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Despite the relevance of kidney transplantation, the supply of organs and the process for inclusion in its waiting list still represent obstacles. This study aimed to analyze the performance of dialysis centers in referring patients for pre-kidney transplant evaluation and inclusion in the waiting list of incident dialysis patients from 2015 to 2019 in the state of Minas Gerais, Brazil. This retrospective cohort study sampled 23,297 records of patients who underwent dialysis therapy in public or philanthropic institutions or who had their treatment funded by the Brazilian Unified National Health System in private clinics. Survival analysis by the Kaplan-Meier method was used to evaluate pre-kidney transplant referral. The strength of the association between the exposure variables and the occurrence of inclusion on the list were analyzed by Cox regression models. Only 14.8% of the sample was enrolled on the pre-kidney transplant waiting list. The cumulative probability of enrollment totaled 1.2% in 180 days and 3.3% in one year from 2016 to 2019. Northern Minas Gerais had the highest cumulative probability of enrollment on the waiting list, whereas its South, the lowest. Adult individuals were more likely to be enrolled than older adults, and enrollment was more likely in 2016 than in 2018 and 2019. Although Ordinance n. 389/2014 from the Brazilian Ministry of Health established the minimum percentage of eligible patients that must be included in the list, this study observed no positive repercussion on the accumulated probability of enrollment in dialysis incidents in subsequent years.