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Leng Y, Li T, Xie R, Jiang X, Li C, Nie Z, Liu D, Wang G. Effectiveness of patient decision aids in patients with advanced kidney disease: a meta-analysis based on randomized controlled trials. Int Urol Nephrol 2024; 56:3295-3305. [PMID: 38862700 DOI: 10.1007/s11255-024-04101-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/29/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE To systematically evaluate the decision effectiveness of patient decision aids (PtDAs) on the decision-making effect of patients with advanced chronic kidney disease. METHOD Two authors independently searched ten electronic databases [Web of science, PubMed, the Cochrane Library, Embase, CINAHL, EBSCO, CBM, CNKI, WanFang DATA and Vip database], to include randomized controlled trials of interventions through PtDAs in patients with advanced chronic kidney disease published from the inception of the database until April 2024. Two authors conducted a comprehensive quality evaluation (Cochrane 5.1.0) before independently extracting and analyzing the data with RevMan 5.2. RESULTS The study included 11 randomized controlled trials with a total of 1613 patients. According to the results, PtDAs can improve the decision knowledge [SMD = 0.53, 95% CI (0.26, 0.80), P = 0.0002] and decision preparation [SMD = 2.34, 95% CI (2.04, 2.65), P < 0.00001] of patients with advanced chronic kidney disease. Additionally, there was a substantial decrease in the levels of decision regret [SMD = - 1.33, 95% CI (- 2.11, - 0.55), P < 0.05] and decision conflict [SMD = - 0.88, 95% CI (- 1.47, - 0.28), P = 0.004]. CONCLUSION The current available evidence indicates that PtDAs can significantly enhance the decision knowledge and decision preparation of patients with advanced chronic kidney disease. Additionally, PtDAs can reduce the levels of decision regret and decision conflict. TRIAL REGISTRY CRD42023433798.
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Affiliation(s)
- Yingjie Leng
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, Sichuan Provence, China
| | - Tao Li
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, Sichuan Provence, China
| | - Ruonan Xie
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, Sichuan Provence, China
| | - Xin Jiang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, Sichuan Provence, China
| | - Chengxiang Li
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, Sichuan Provence, China
| | - Zhuomiao Nie
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, Sichuan Provence, China
| | - Daiqing Liu
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610056, Sichuan Provence, China
| | - Guorong Wang
- West China School of Public Health and West China Fourth Hospital, West China Nursing School, Sichuan University, Chengdu, 610041, Sichuan Provence, China.
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Xu S, Wu W, Cheng J. Comparison of outcomes of incremental vs. standard peritoneal dialysis: a systematic review and meta-analysis. BMC Nephrol 2024; 25:308. [PMID: 39285336 PMCID: PMC11406953 DOI: 10.1186/s12882-024-03669-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 07/12/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND Incremental peritoneal dialysis (IPD) refers to the use of less than standard full-dose peritoneal dialysis (SPD) in end-stage renal disease patients. While the use of IPD is being reported in the literature, its safety and efficacy vs. SPD is unclear. We hereby performed a systematic review of studies comparing mortality, peritonitis, technique survival, anuria-free survival and residual renal function (RRF) between IPD and SPD. METHODS All comparative studies published on PubMed, Embase, CENTRAL, Scopus, and Web of Science databases from inception to 5th September 2023 and reporting on given outcomes were eligible. RESULTS Ten studies were included. Definitions of IPD were heterogenous and hence mostly a qualitative synthesis was undertaken. Majority of studies found no difference in patient survival between IPD and SPD. Meta-analysis of crude mortality data also presented no significant difference. Peritonitis and technique survival were also not significantly different between IPD and SPD in the majority of studies. Data on RRF was conflicting. Some studies showed that IPD was associated with the preservation of RRF while others found no such difference. CONCLUSION IPD may be a safe alternative to SPD in incident dialysis patients. There seems to be no difference in patient survival, peritonitis, and technique survival between the two modalities. However, the impact of IPD on RRF is still questionable. Evidence is heterogeneous and conflicting to derive firm conclusions.
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Affiliation(s)
- Shuang Xu
- Department of Nephrology and Urology, Huzhou Central Hospital, Affiliated Central Hospital HuZhou University, 1558 North Sanhuan Road, Huzhou, Zhejiang Province, 313000, China
| | - Weifei Wu
- Department of Nephrology, Huzhou Central Hospital, Affiliated Central Hospital HuZhou University, Huzhou, Zhejiang Province, China
| | - Jing Cheng
- Department of Nephrology and Urology, Huzhou Central Hospital, Affiliated Central Hospital HuZhou University, 1558 North Sanhuan Road, Huzhou, Zhejiang Province, 313000, China.
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Albert A, Richter S, Kalk P, Stieger P, Woitas RP, Braun-Dullaeus RC, Albert C. Analysis of a nurse-provided on-call peritoneal dialysis support in an outpatient reference care centre. BMC Nurs 2024; 23:144. [PMID: 38429782 PMCID: PMC10905825 DOI: 10.1186/s12912-024-01812-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/20/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND To analyse the nature of medical or technical emergency issues of ambulatory peritoneal dialysis (PD) patients calling a nurse-provided emergency PD support service of a reference centre that is provided all year in the after-hours. METHODS We retrospectively analysed patients' chief complaint, urgency, resolution of and association to current PD treatment and modality directed to an on-call nurse-provided PD support service from 2015-2021 based on routinely collected health data. Calls were systematically categorized being technical/procedural-, medical-, material-related or type of correspondence. Call urgency was categorized to have "immediate consequence", inquiry was eligible for "processing next working day" or whether there was "no need for further action". Call outcomes were classified according to whether patients were able to initiate, resume or finalize their treatments or whether additional interventions were required. Unexpected adverse events such as patients' acute hospitalization or need for nurses' home visits were evaluated and quantified. RESULTS In total 753 calls were documented. Most calls were made around 7:30 a.m. (5:00-9:00; median, 25-75th CI) and 6:30 p.m. (5:00-8:15). 645 calls were assigned to continuous ambulatory- (CAPD) or automated PD (APD). Of those, 430 calls (66.7%) had an "immediate consequence". Of those 77% (N = 331) were technical/procedural-, 12.8% (N = 55) medical- and 6.3% (N = 27) material related issues. 4% (N = 17) were categorized as other correspondence. Issues disrupting the course of PD were identified in 413 cases. In 77.5% (N = 320) patients were able to initiate, resume or finalize their treatment after phone consultation. Last-bag exchange was used in 6.1% enabling continued therapy in 83.6%. In 35 cases a nurse visit at patients' home or patients' visit to the practice at the earliest possible date were required, while hospitalization was required in seven medical category cases (5.4% and 1.09% of total assessed calls, respectively). CONCLUSION The on-call PD-nurse provides patient support for acute and imminent issues enabling them to successfully initiate, resume or finalize their prescribed treatment. Nurses triage of acute conditions facilitated rapid diagnostics and therapy. Maintaining quality PD homecare, the provision of trained personnel is indispensable. The information gathered in this study may therefore be used as a foundation to tailor educational programs for nephrology nurses and doctors to further develop their competencies in PD.
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Affiliation(s)
- Annemarie Albert
- Diaverum Renal Services, Am Neuen Garten 11, Potsdam, 14469, Germany
- Department of Nephrology and Endocrinology, Ernst von Bergmann Hospital, Charlottenstraße 72, Potsdam, 14467, Germany
| | - Stefan Richter
- Diaverum Renal Services, Am Neuen Garten 11, Potsdam, 14469, Germany
| | - Philipp Kalk
- Diaverum Renal Services, Am Neuen Garten 11, Potsdam, 14469, Germany
| | - Philipp Stieger
- University Clinic for Cardiology and Angiology, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, 39120, Germany
| | | | - Rüdiger C Braun-Dullaeus
- University Clinic for Cardiology and Angiology, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, 39120, Germany
| | - Christian Albert
- Diaverum Renal Services, Am Neuen Garten 11, Potsdam, 14469, Germany.
- University Clinic for Cardiology and Angiology, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, 39120, Germany.
- Department of Nephrology, Central Clinic Bad Berka, Robert-Koch-Allee 9, Bad Berka, 99438, Germany.
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Lokhande A, Painter DF, Vogt B, Shah A. Policy and Payment Decisions on Peritoneal Dialysis in the United States: A Review. Med Care Res Rev 2024:10775587241233614. [PMID: 38404115 DOI: 10.1177/10775587241233614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
End-stage kidney disease (ESKD) accounts for a sizable proportion of Medicare spending. Peritoneal dialysis remains an underutilized treatment modality for ESKD despite its quality of life and cost-saving benefits. Medicare policy on reimbursements and patient eligibility for dialysis coverage has been amended numerous times since its inception in 1972. Over the last two decades, Medicare policy on ESKD reimbursements has evolved from a primarily fee-for-service model to a prospective payment system, and within the past few years, it has begun including more experimental payment structures. While prior work has explored the evolution of Medicare's ESKD policy as a whole, we specifically outline the impact of Medicare policy changes on peritoneal dialysis reimbursement rates, uptake by physicians and dialysis facilities, and accessibility to patients. This narrative review offers historical insights, an overview of modern ESKD policy, actionable strategies, and policy opportunities to increase the accessibility of this treatment modality.
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Affiliation(s)
- Anagha Lokhande
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - David F Painter
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Braden Vogt
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ankur Shah
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, USA
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Liu R, Ye H, Peng Y, Yi C, Lin J, Wu H, Diao X, Mao H, Huang F, Yang X. Incremental peritoneal dialysis and survival outcomes: a propensity-matched cohort study. J Nephrol 2023; 36:1907-1919. [PMID: 37603146 DOI: 10.1007/s40620-023-01735-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 07/07/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND The advantages of an incremental dialysis start are not fully clear. We aimed to evaluate the association of incremental initiation of peritoneal dialysis with mortality. METHODS Incident peritoneal dialysis patients with a catheter placed at our hospital between 2008 and 2017 were included. All patients were followed up until December 31, 2019. Patients were categorized into different groups according to the initial daily dialysis exchanges, and were matched at a ratio of 1:2 with propensity score matching. Multiple variables including age, sex, residual kidney function, urine volume, hemoglobin, serum albumin and other important variables were included for the matching. Primary outcomes were all-cause and cardiovascular mortality. RESULTS A total of 1315 patients with a mean age of 45.9 years were enrolled. The mean glomerular filtration rate was 4.32 ml/min/1.73 m2 at start of dialysis. Two hundred eighty-five patients in the incremental group and 502 in the full dose group were matched for age, sex, residual kidney function, urine volume, hemoglobin, serum albumin and other important variables. Patient survival and cardiovascular event-free survival were similar between the two groups. However, during the first 6 years of peritoneal dialysis, patients in the incremental group had better survival (P = 0.011) and cardiovascular event-free survival (P = 0.044) than the full dose group, while such advantages disappeared when dialysis vintage became longer. Further analysis showed that the incremental group (vs full dose dialysis) had a 39% lower risk (95% CI 0.42-0.90, P = 0.012) of all-cause mortality and a 41% decreased risk (95% CI 0.35-0.99, P = 0.047) of cardiovascular mortality during the first 6 years of dialysis. Additionally, the cumulative hazard for anuria was significantly lower in the incremental group versus the full dose group (P = 0.006). CONCLUSIONS Our study shows a time-related survival advantage for incremental peritoneal dialysis patients, suggesting that an incremental regimen for starting peritoneal dialysis is feasible and is not associated with worse outcomes. Graphical Abstract presenting schematically the measurements of the solvation response function by processing the relevant streak camera images and the time-correlated photon counting (TCSPC) data and appropriately combining them together.
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Affiliation(s)
- Ruihua Liu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, 510080, China
| | - Hongjian Ye
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, 510080, China
| | - Yuan Peng
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, 510080, China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Jianxiong Lin
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Haishan Wu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, 510080, China
| | - Xiangwen Diao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, 510080, China
| | - Haiping Mao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, 510080, China
| | - Fengxian Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, 510080, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China.
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, 510080, China.
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Qureshi MA, Hamidi S, Auguste BL. Five Things to Know About Incremental Peritoneal Dialysis. Can J Kidney Health Dis 2023; 10:20543581231192748. [PMID: 37577176 PMCID: PMC10422902 DOI: 10.1177/20543581231192748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/23/2023] [Indexed: 08/15/2023] Open
Abstract
Incremental peritoneal dialysis (PD) offers patients newly starting dialysis less than the standard "full dose" of PD, reducing treatment burden and intrusiveness while minimizing symptoms of renal failure. Incremental PD is a cost-effective approach that has been associated with slower rates of decline in residual kidney function. This approach also produces less waste and in turn reduces environmental footprint compared to standard PD prescriptions. It also aligns with the International Society of Peritoneal Dialysis (ISPD) Practice Recommendations for high-quality, goal-oriented therapy. Awareness of incremental PD along with its advantages and limitations provides practitioners with the tools to provide more patient-centered dialysis prescriptions in appropriate populations.
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Affiliation(s)
- Mohammed Azfar Qureshi
- Department of Medicine, University of Toronto, ON, Canada
- Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Shabnam Hamidi
- Department of Medicine, University of Toronto, ON, Canada
- Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Bourne L. Auguste
- Department of Medicine, University of Toronto, ON, Canada
- Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Centre for Quality Improvement and Patient Safety, University of Toronto, ON, Canada
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Fernandes A, Matias P, Branco P. Incremental Peritoneal Dialysis-Definition, Prescription, and Clinical Outcomes. KIDNEY360 2023; 4:272-277. [PMID: 36821618 PMCID: PMC10103348 DOI: 10.34067/kid.0006902022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
ABSTRACT Incremental peritoneal dialysis (IPD) is a strategy of RRT that is based on the prescription of a lower dose rather than the standard full dose of peritoneal dialysis (PD). The clearance goals are achieved through the combination of residual kidney function (RKF) and peritoneal clearance. The dialysis prescription should be increased as the RKF declines. IPD has been associated with clinical, economic, and environmental advantages. We emphasize possible better quality of life, fewer mechanical symptoms, lower costs, slight adverse metabolic effects, and less plastic waste and water consumption. The potential benefits for RKF preservation and the lower risk of peritonitis have also been discussed. There are some concerns regarding this strategy, such as inadequate clearance of uremic toxins and/or severe electrolyte disturbances due to undetected loss of RKF, lower clearance of medium-sized molecules (such as β-2-microglobulin) which mostly depends on the total PD dwell time, and patients' reluctance to dose adjustments. Current clinical evidence is based on moderate-quality to low-quality studies and suggests that the outcomes of IPD will be at least identical to those of full dose. This review aims to define IDP, discuss strategies for prescription, and review its advantages and disadvantages according to the current evidence.
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Affiliation(s)
| | - Patrícia Matias
- Nephrology Department, Hospital de Santa Cruz, Carnaxide, Portugal
| | - Patrícia Branco
- Nephrology Department, Hospital de Santa Cruz, Carnaxide, Portugal
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Calice-Silva V, Nerbass FB. Incremental peritoneal dialysis after unplanned start initiation. FRONTIERS IN NEPHROLOGY 2022; 2:932562. [PMID: 37675037 PMCID: PMC10479764 DOI: 10.3389/fneph.2022.932562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/28/2022] [Indexed: 09/08/2023]
Abstract
Incremental peritoneal dialysis (PD) is characterized as less than a "standard dose" PD prescription. Compared to standard treatment, it has many potential advantages, including better preservation of residual renal function, a lower risk of peritonitis, and a decreased care delivery burden while reducing the environmental impact and economic cost. Unplanned PD can be defined when treatment starts up to 14 days after catheter insertion and is recognized as a safe and feasible clinical approach. In this perspective paper, we briefly discuss both strategies and share our experience and clinical routine in managing incremental PD after unplanned initiation.
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Affiliation(s)
- Viviane Calice-Silva
- Nephrology Division, Pro-rim Foundation, Joinville, Brazil
- Medicine School, Universidade da Região de Joinville (Univille), Joinville, Brazil
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Sokas C, Cooper Z, Salim A, Rodrigue JR, Adler JT. Wait expectations: The impact of delisting as an outcome from the kidney transplant waitlist. Clin Transplant 2021; 35:e14250. [PMID: 33565145 DOI: 10.1111/ctr.14250] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/08/2021] [Accepted: 02/04/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND While kidney transplantation is optimal for the treatment of end-stage kidney disease, available organs do not meet demand. Little is known about the outcomes of patients who are delisted (removed from the waitlist) and unable to benefit from transplant. We describe patients who are delisted and their life expectancy after delisting. METHODS Patients ≥ 18 years listed for deceased donor kidney transplant between 01/2003 and 12/2013 were identified in the Scientific Registry of Transplant Recipients and followed through 12/2018. A competing risk model was used to measure the association of demographic and clinical factors with waitlist outcomes of delisting, transplant, and death. Multivariate Cox modeling was used to evaluate factors associated with death after delisting. RESULTS Of 324,582 patients listed, 18.0% were delisted, most common reasons were "too sick" or "other." After delisting, half (49.7%) had died by end of follow-up; time to death after removal was 5 years. Increasing age and public insurance were associated with increased risk of death. CONCLUSIONS Nearly one in five patients will be delisted from the kidney transplant waitlist. These patients live a surprisingly long time after removal. Much remains unknown about these patients, which could be improved through data collection. Delisting is an important patient outcome that warrants further exploration.
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Affiliation(s)
- Claire Sokas
- Center for Surgery and Public Health at Brigham and Women's Hospital, Boston, MA, USA.,Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Zara Cooper
- Center for Surgery and Public Health at Brigham and Women's Hospital, Boston, MA, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Ali Salim
- Center for Surgery and Public Health at Brigham and Women's Hospital, Boston, MA, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - James R Rodrigue
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Joel T Adler
- Center for Surgery and Public Health at Brigham and Women's Hospital, Boston, MA, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
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