scholarly journals Incorrect Wording in: Access to Kidney Transplantation Among Remote and Rural-Dwelling Patients With Kidney Failure in the United States

JAMA ◽  
2009 ◽  
Vol 301 (22) ◽  
pp. 2329
Keyword(s):  
United States ◽  
Kidney Transplantation ◽  
Kidney Failure ◽  
The United States

Dialysis Facility Profit Status and Early Steps in Kidney Transplantation in the Southeastern United States

2021 ◽  
pp. CJN.17691120
Author(s):  
Laura J. McPherson ◽  
Elizabeth R. Walker ◽  
Yi-Ting Hana Lee ◽  
Jennifer C. Gander ◽  
Zhensheng Wang ◽  
...  
Keyword(s):  
United States ◽  
Cohort Study ◽  
Kidney Transplantation ◽  
Confidence Interval ◽  
Kidney Failure ◽  
The United States ◽  
For Profit ◽  
Transplant Center ◽  
Dialysis Facility ◽  
Profit Status

Background and objectivesDialysis facilities in the United States play a key role in access to kidney transplantation. Previous studies reported that patients treated at for-profit facilities are less likely to be waitlisted and receive a transplant, but their effect on early steps in the transplant process is unknown. The study’s objective was to determine the association between dialysis facility profit status and critical steps in the transplantation process in Georgia, North Carolina, and South Carolina.Design, setting, participants, & measurementsIn this retrospective cohort study, we linked referral and evaluation data from all nine transplant centers in the Southeast with United States Renal Data System surveillance data. The cohort study included 33,651 patients with kidney failure initiating dialysis from January 1, 2012 to August 31, 2016. Patients were censored for event (date of referral, evaluation, or waitlisting), death, or end of study (August 31, 2017 for referral and March 1, 2018 for evaluation and waitlisting). The primary exposure was dialysis facility profit status: for profit versus nonprofit. The primary outcome was referral for evaluation at a transplant center after dialysis initiation. Secondary outcomes were start of evaluation at a transplant center after referral and waitlisting.ResultsOf the 33,651 patients with incident kidney failure, most received dialysis treatment at a for-profit facility (85%). For-profit (versus nonprofit) facilities had a lower cumulative incidence difference for referral within 1 year of dialysis (−4.5%; 95% confidence interval, −6.0% to −3.2%). In adjusted analyses, for-profit versus nonprofit facilities had lower referral (hazard ratio, 0.84; 95% confidence interval, 0.80 to 0.88). Start of evaluation within 6 months of referral (−1.0%; 95% confidence interval, −3.1% to 1.3%) and waitlisting within 6 months of evaluation (1.0%; 95% confidence interval, −1.2 to 3.3) did not meaningfully differ between groups.ConclusionsFindings suggest lower access to referral among patients dialyzing in for-profit facilities in the Southeast United States, but no difference in starting the evaluation and waitlisting by facility profit status.

1488-P: Closing the Racial/Ethnic Disparity Gap in Kidney Failure from Diabetes in the United States, 2000-2016

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1488-P
Author(s):  
NILKA RIOS BURROWS ◽  
YAN ZHANG ◽  
ISRAEL A. HORA ◽  
MEDA E. PAVKOV ◽  
GIUSEPPINA IMPERATORE
Keyword(s):  
United States ◽  
Kidney Failure ◽  
The United States ◽  
Ethnic Disparity ◽  
Racial Ethnic

Medicaid Expansion and Incidence of Kidney Failure among Nonelderly Adults

2021 ◽  
pp. ASN.2020101511
Author(s):  
Rebecca Thorsness ◽  
Shailender Swaminathan ◽  
Yoojin Lee ◽  
Benjamin D. Sommers ◽  
Rajnish Mehrotra ◽  
...  
Keyword(s):  
United States ◽  
Incidence Rate ◽  
Kidney Failure ◽  
The United States ◽  
Early Years ◽  
Relative Reduction ◽  
Medicaid Expansion ◽  
Expansion Time ◽  
Incident Cases ◽  
Medicaid Expansions

BackgroundLow-income individuals without health insurance have limited access to health care. Medicaid expansions may reduce kidney failure incidence by improving access to chronic disease care.MethodsUsing a difference-in-differences analysis, we examined the association between Medicaid expansion status under the Affordable Care Act (ACA) and the kidney failure incidence rate among all nonelderly adults, aged 19–64 years, in the United States, from 2012 through 2018. We compared changes in kidney failure incidence in states that implemented Medicaid expansions with concurrent changes in nonexpansion states during pre-expansion, early postexpansion (years 2 and 3 postexpansion), and later postexpansion (years 4 and 5 postexpansion).ResultsThe unadjusted kidney failure incidence rate increased in the early years of the study period in both expansion and nonexpansion states before stabilizing. After adjustment for population sociodemographic characteristics, Medicaid expansion status was associated with 2.20 fewer incident cases of kidney failure per million adults per quarter in the early postexpansion period (95% CI, −3.89 to −0.51) compared with nonexpansion status, a 3.07% relative reduction (95% CI, −5.43% to −0.72%). In the later postexpansion period, Medicaid expansion status was not associated with a statistically significant change in kidney failure incidence (−0.56 cases per million per quarter; 95% CI, −2.71 to 1.58) compared with nonexpansion status and the pre-expansion time period.ConclusionsThe ACA Medicaid expansion was associated with an initial reduction in kidney failure incidence among the entire, nonelderly, adult population in the United States; but the changes did not persist in the later postexpansion period. Further study is needed to determine the long-term association between Medicaid expansion and changes in kidney failure incidence.

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