CONTEXT: US residents with end-stage renal disease (ESRD) may live far away from the closest transplant center, which could compromise their access to kidney transplantation. OBJECTIVE: To assess access to kidney transplantation as a function of distance from the closest transplant center or as a function of rural rather than urban residence. DESIGN, SETTING, AND PARTICIPANTS: Observational study of 699,751 adult patients with kidney failure who had initiated renal replacement in the United States between 1995 and 2007 and were thus placed on a prospective mandatory registry list. MAIN OUTCOME MEASURES: Time to placement on the kidney transplant waiting list and time to kidney transplantation, both measured at the start of renal replacement. RESULTS: During a median follow-up of 2.0 years (range, 0.0-12.5 years), 122,785 (17.5%) patients received a kidney transplant. Median distance to the closest transplant center was 15 miles. Participants were classified into distance categories by miles from a transplant center with 0 to 15 miles serving as the referent category. Compared with the referent category, the adjusted hazard ratios of deceased or living donor transplantation within each category follows: 16 to 50 miles, 1.03 (95% CI, 1.02-1.05); 51 to 100 miles, 1.11 (95% CI, 1.09-1.12); 101 to 136 miles, 1.14 (95% CI, 1.11-1.17); 137 to 231 miles, 1.16 (95% CI, 1.13-1.20); 232 to 310 miles, 1.20 (95% CI, 1.12-1.28); and more than 310 miles, 1.16 (95% CI, 1.09-1.23). When residence location was classified using rural-urban commuter areas, 79.6% of patients lived in urban; 10.3%, micropolitan; and 10.0%, rural areas. Compared with those living in metropolitan areas, the adjusted hazard ratios of deceased or living donor transplantation among patients residing in micropolitan communities was 1.13 (95% CI, 1.11-1.15) and 1.15 (95% CI, 1.13-1.18) for rural areas. Results were similar for both deceased donor and living donor transplantation and were consistent in multiple sensitivity analyses. CONCLUSION: Remote or rural residence was not associated with increased time to kidney transplantation among people treated for ESRD in the United States.
CONTEXT: US residents with end-stage renal disease (ESRD) may live far away from the closest transplant center, which could compromise their access to kidney transplantation. OBJECTIVE: To assess access to kidney transplantation as a function of distance from the closest transplant center or as a function of rural rather than urban residence. DESIGN, SETTING, AND PARTICIPANTS: Observational study of 699,751 adult patients with kidney failure who had initiated renal replacement in the United States between 1995 and 2007 and were thus placed on a prospective mandatory registry list. MAIN OUTCOME MEASURES: Time to placement on the kidney transplant waiting list and time to kidney transplantation, both measured at the start of renal replacement. RESULTS: During a median follow-up of 2.0 years (range, 0.0-12.5 years), 122,785 (17.5%) patients received a kidney transplant. Median distance to the closest transplant center was 15 miles. Participants were classified into distance categories by miles from a transplant center with 0 to 15 miles serving as the referent category. Compared with the referent category, the adjusted hazard ratios of deceased or living donor transplantation within each category follows: 16 to 50 miles, 1.03 (95% CI, 1.02-1.05); 51 to 100 miles, 1.11 (95% CI, 1.09-1.12); 101 to 136 miles, 1.14 (95% CI, 1.11-1.17); 137 to 231 miles, 1.16 (95% CI, 1.13-1.20); 232 to 310 miles, 1.20 (95% CI, 1.12-1.28); and more than 310 miles, 1.16 (95% CI, 1.09-1.23). When residence location was classified using rural-urban commuter areas, 79.6% of patients lived in urban; 10.3%, micropolitan; and 10.0%, rural areas. Compared with those living in metropolitan areas, the adjusted hazard ratios of deceased or living donor transplantation among patients residing in micropolitan communities was 1.13 (95% CI, 1.11-1.15) and 1.15 (95% CI, 1.13-1.18) for rural areas. Results were similar for both deceased donor and living donor transplantation and were consistent in multiple sensitivity analyses. CONCLUSION: Remote or rural residence was not associated with increased time to kidney transplantation among people treated for ESRD in the United States.
Authors: Jennifer Gander; Teri Browne; Laura Plantinga; Stephen O Pastan; Leighann Sauls; Jenna Krisher; Rachel E Patzer Journal: Am J Nephrol Date: 2015-08-06 Impact factor: 3.754
Authors: Courtenay M Holscher; Satinderjit S Locham; Christine E Haugen; Sunjae Bae; Dorry L Segev; Mahmoud B Malas Journal: J Nephrol Date: 2019-01-02 Impact factor: 3.902
Authors: Sumit Mohan; Richard Mutell; Rachel E Patzer; James Holt; David Cohen; William McClellan Journal: Transplantation Date: 2014-09-27 Impact factor: 4.939
Authors: F L Weng; D C Lee; N Dhillon; K N Tibaldi; L A Davis; A M Patel; R J Goldberg; M Morgievich; S Mulgaonkar Journal: Transplant Proc Date: 2016 Jul-Aug Impact factor: 1.066