Dialysis – Transplantation
Kidney International (2005) 68, 330–337; doi:10.1111/j.1523-1755.2005.00412.x
Kidney transplantation and wait-listing rates from the international Dialysis Outcomes and Practice Patterns Study (DOPPS)
SUDITIDA SATAYATHUM, RONALD L PISONI, KEITH P MCCULLOUGH, ROBERT M MERION, BJORN WIKSTRÖM, NATHAN LEVIN, KENNETH CHEN, ROBERT A WOLFE, DAVID A GOODKIN1, LUIS PIERA, YASUSHI ASANO, KIYOSHI KUROKAWA, SHUNICHI FUKUHARA, PHILIP J HELD and FRIEDRICH K PORT
University Renal Research and Education Association, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan; Nephrology, Uppsala Universitet, Uppsala, Sweden; Renal Research Institute, New York, New York; Amgen, Inc., Thousand Oaks, California; Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan; Hospital General, Vall d'Hebron, Barcelona, Spain; Jichi Medical School and Sashima Red Cross Hospital, Ibaraki, Japan; The Institute of Medical Sciences, Tokai University, Isehara, Kanagawa, Japan; and School of Medicine, Kyoto University, Kyoto, Japan
Correspondence: Friedrich K. Port, M.D., M.S., University Renal Research and Education Association, 315 W. Huron, Suite 260, Ann Arbor, MI 48103. E-mail: dopps@urrea.org.
1Dr. Goodkin is currently working at ICOS Corporation, Bothell, Washington.
Received 4 February 2004; Revised 18 August 2004; Accepted 27 January 2005.
Abstract
Kidney transplantation and wait-listing rates from the international Dialysis Outcomes and Practice Patterns Study (DOPPS).
Background
The international Dialysis Outcomes and Practice Patterns Study (DOPPS I and II) allows description of variations in kidney transplantation and wait-listing from nationally representative samples of 18- to 65-year-old hemodialysis patients. The present study examines the health status and socioeconomic characteristics of United States patients, the role of for-profit versus not-for-profit status of dialysis facilities, and the likelihood of transplant wait-listing and transplantation rates.
Methods
Analyses of transplantation rates were based on 5267 randomly selected DOPPS I patients in dialysis units in the United States, Europe, and Japan who received chronic hemodialysis therapy for at least 90 days in 2000. Left-truncated Cox regression was used to assess time to kidney transplantation. Logistic regression determined the odds of being transplant wait-listed for a cross-section of 1323 hemodialysis patients in the United States in 2000. Furthermore, kidney transplant wait-listing was determined in 12 countries from cross-sectional samples of DOPPS II hemodialysis patients in 2002 to 2003 (N = 4274).
Results
Transplantation rates varied widely, from very low in Japan to 25-fold higher in the United States and 75-fold higher in Spain (both P values <0.0001). Factors associated with higher rates of transplantation included younger age, nonblack race, less comorbidity, fewer years on dialysis, higher income, and higher education levels. The likelihood of being wait-listed showed wide variation internationally and by United States region but not by for-profit dialysis unit status within the United States.
Conclusion
DOPPS I and II confirmed large variations in kidney transplantation rates by country, even after adjusting for differences in case mix. Facility size and, in the United States, profit status, were not associated with varying transplantation rates. International results consistently showed higher transplantation rates for younger, healthier, better-educated, and higher income patients.
Keywords:
cadaveric kidney transplantation, end-stage renal disease, socioeconomic status, transplantation access, transplant wait-listing
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