N. Gupta1, L. M. Kucirka2, M. L. Salter2, A. H. Law2, K. S. Balhara3, D. L. Segev1,2 1Johns Hopkins University School Of Medicine,Department Of Surgery,Baltimore, MD, USA 2Johns Hopkins University School Of Public Health,Department of Epidemiology,Baltimore, MD, USA 3Johns Hopkins University School Of Medicine,Department Of Emergency Medicine,Baltimore, MD, USA
Introduction: Nephrologists play a key role in educating dialysis patients about kidney transplantation (KT). In fact, informed consent for dialysis should, by definition, involve a discussion of alternate therapies such as KT; furthermore, Medicare requires such a discussion about KT for reimbursement for dialysis care. However, little is known about (1) how much time nephrologists spend with their patients in these discussions, (2) the relationship between patient characteristics and time spent discussing KT, and (3) the relationship between time spent discussing KT and subsequent access to and pursuit of KT.
Methods: We conducted a cross-sectional survey of prevalent dialysis patients recruited from four Davita dialysis centers across Maryland to assess patient-reported time spent discussing KT with a nephrologist. Eligibility criteria included no prior history of transplant. Subsequent access to KT was ascertained via linkage to SRTR and was defined as receiving a transplant from a live donor or registering for the deceased donor waitlist. We used modified Poisson regression to quantify the relationship between patient characteristics, including time spent discussing KT with a nephrologist, and access to KT. We used ordered logistic regression to quantify the relationship between patient characteristics and time spent discussing KT with a nephrologist.
Results: Of 254 patients surveyed, 40.9% reported 0 minutes, 37.4% reported 1- 20 minutes, 11.4% reported 21-30 minutes, 3.1% reported 31-45 minutes, and 7.1% reported greater than 45 minutes of KT discussion with a nephrologist. Age greater than 50 years (aRR 0.47, 95% CI: 0.25-0.89, p-value=0.02) was associated with decreased odds of discussing KT for >20 minutes. Overall, 16.1% achieved access to KT. Age greater than 50 years (adjusted RR [aRR] 0.49, 95% CI: 0.28-0.83, p-value=0.008) was associated with decreased access to KT. Reporting 21-30 minutes (aRR 6.67, 95% CI: 2.89-15.37, p-value<0.001), reporting 31-45 minutes (aRR 8.20, 95% CI: 3.13-21.49, p-value<0.001), and reporting >45 minutes (aRR 4.77, 95% CI: 1.79-12.66, p-value=0.002) were associated with increased access to KT.
Conclusion: Nephrologist discussions of longer than 20 minutes were associated with increased access to and/or pursuit of KT. However, only 60% of patients reported discussing KT with their nephrologist, despite 100% requirement by Medicare. Facilitating increased discussion of KT between patients and nephrologists may increase access to surgical care.