April 17, 2020
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Patient distance from home to center shows no impact on kidney transplantation odds

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For patients seeking kidney transplantation in the Southeastern United States, center distance from residence did not appear to be associated with either referral to transplant center or initiation of evaluation, according to a recently published study.

“There is some indication that the 262 U.S. adult transplant centers may not be as geographically widespread as the [greater than] 7,000 dialysis facilities, and thus less accessible to referred patients on dialysis,” Laura J. McPherson, MPH, of Emory University School of Medicine in Georgia, and colleagues wrote. “Previous studies suggest the average one-way driving distance from a patient’s home to the nearest dialysis facility is 7.9 miles, while the mean distance between a transplant patient’s home and the nearest transplant center is 23 miles.”

Arguing that patients and nephrologists — especially those from rural areas — may view distance as a barrier to transplantation, researchers sought to explore the impact of distance on referral from dialysis facilities and on the initiation of evaluation for transplant. They contended that, due to the lack of national surveillance data, this is an area in need of investigation, because these early steps in the transplant process have been less well-studied than later steps (eg, placement on a wait list and receipt of transplant).

Using data from the United States Renal Data System, researchers identified 27,250 patients who initiated dialysis at a facility in Georgia, North Carolina or South Carolina between 2012 and 2015. Distance from patients’ residential ZIP code to nearest center was categorized as less than 15 miles, 15 to 30 miles, 31 to 60 miles, 61 to 90 miles and more than 90 miles.

After accounting for patient and dialysis facility-level characteristics, as well as neighborhood-level sociodemographic and socioeconomic characteristic, researchers determined distance was not statistically significantly associated with transplant referral (adjusted ORs= 1,08, 1.07, 0.96 and 0.87 for 15 miles to 30 miles, 31 miles to 60 miles, 61 miles to 90 miles and >90 miles, respectively, compared with <15 miles) or evaluation initiation among referred patients (aORs= 1.14, 1.12, 1.04 and 0.89 for 15 to 30 miles, 31 miles to 60 miles, 61 miles to 90 miles and >90 miles vs. <15).

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Reference: CJASN

“Our results indicate that distance from patient ZIP code to the nearest transplant center may not be the driving force in accessing the early steps in the kidney transplant process, referral, and evaluation initiation, among patients in the Southeastern U.S.,” McPherson said in a related press release. “Other unmeasured factors in the genre of distance, such as travel time or transportation options, may have a larger impact on these early steps and should be further examined.” She also suggested research be done in this area to explore whether results are similar across the United States.

In a related editorial, Tanjala S. Purnell, PhD, MPH, and Mara McAdams-DeMarco, PhD, both of Johns Hopkins University School of Medicine, commended the authors for considering “important subgroups that may be most vulnerable to having to travel far distances to a transplant center.” However, they emphasized that patient race/ethnicity, socioeconomic status, neighborhood poverty and location (urban/rural) did not seem to affect the process. “These findings further confirmed the limited role of transplant center distance to disparities in KT access among many vulnerable patients,” they wrote.

Lisa Gardner, a two-time kidney transplant recipient, provided a patient perspective on the study in which she focused on financial consequences for people living with kidney disease. In it, she wrote: “It is interesting that many are not concerned about the time or travel barriers, they are concerned about affording the immunosuppressant drugs after the 36-month time allowance for Medicare to assist in the cost of this life of the organ saving drug. They feel that the time and effort that they have invested in getting listed for the transplant, the transplant surgery and recovery are in vain, because many simply can’t afford the drugs needed to sustain the transplanted organ and help prevent rejection.” – by Melissa J. Webb

Disclosures: McPherson reports no relevant financial disclosure. Please see the study for all other authors’ relevant financial disclosures.