Indicators of Increased Access to Quality Care Among End Stage Renal Disease Patients Preemptively Referred for Transplantation.

Abstract

Background: Little is known about whether preemptive referral [referral for kidney transplant (KTx) evaluation prior to initiating dialysis] is associated with indicators of access to quality care among End Stage Renal Disease (ESRD) patients. Methods: KTx center-level data for 4,825 patients with no previous transplant who had been on dialysis and were referred for KTx evaluation from 2005-2010 were linked with United States Renal Data System baseline and follow-up data through September 2011. Chi-square tests were used to examine the association between preemptive referral and indicators of increased access to quality care [private insurance, pre-ESRD nephrology care, erythropoietin use, normal hemoglobin (≥10.0 g/dl) and albumin levels (≥3.5 g/dl)] at the time of ESRD start. Results: Of the 4,825 referred patients, 845 (17.5%) had been referred prior to initiating dialysis. Preemptively referred patients were significantly more likely than patients referred after dialysis start to have private insurance (vs. Medicare or Medicaid), pre-ESRD nephrology care, erythropoietin use, and normal hemoglobin and albumin levels (Table).Table: Indicators of Quality Care in Preemptively Referred vs. Non-Preemptively Referred PatientsConclusions: Preemptive referral for KTx evaluation is associated with indicators of increased access to quality care, which may explain improved outcomes for patients with preemptive referral compared to those referred after dialysis start.