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Variation in Access to Kidney Transplantation Across Renal Programs in Ontario, Canada.
Naylor, K L; Dixon, S N; Garg, A X; Kim, S J; Blake, P G; Nesrallah, G E; McCallum, M K; D'Antonio, C; Li, A H; Knoll, G A.
Afiliación
  • Naylor KL; Institute for Clinical Evaluative Sciences (ICES), London, Ontario, Canada.
  • Dixon SN; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
  • Garg AX; Institute for Clinical Evaluative Sciences (ICES), London, Ontario, Canada.
  • Kim SJ; Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada.
  • Blake PG; Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada.
  • Nesrallah GE; Division of Nephrology, Western University, London, Ontario, Canada.
  • McCallum MK; Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
  • D'Antonio C; Division of Nephrology, Western University, London, Ontario, Canada.
  • Li AH; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
  • Knoll GA; Nephrology Program, Humber River Hospital, Toronto, Ontario, Canada.
Am J Transplant ; 17(6): 1585-1593, 2017 Jun.
Article en En | MEDLINE | ID: mdl-28068455
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Sistema de Registros / Diálisis Renal / Trasplante de Riñón / Accesibilidad a los Servicios de Salud / Fallo Renal Crónico Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Determinantes_sociais_saude Límite: Adolescent / Adult / Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Am J Transplant Asunto de la revista: TRANSPLANTE Año: 2017 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Sistema de Registros / Diálisis Renal / Trasplante de Riñón / Accesibilidad a los Servicios de Salud / Fallo Renal Crónico Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Determinantes_sociais_saude Límite: Adolescent / Adult / Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Am J Transplant Asunto de la revista: TRANSPLANTE Año: 2017 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Estados Unidos