Public Release: 

Equations used to place patients on transplant waitlists may create disparities

American Society of Nephrology

Highlights

  • Three commonly used kidney function equations yielded discordant results for transplant waitlist qualification in a recent analysis.
  • The findings, which point to the need for revised kidney transplant policies, will be presented at ASN Kidney Week 2015 November 3-8 at the San Diego Convention Center in San Diego, CA.

San Diego, CA (November 6, 2015) -- Different equations used to qualify patients for the kidney transplant waitlist may result in inequities, according to a study that will be presented at ASN Kidney Week 2015 November 3¬-8 at the San Diego Convention Center in San Diego, CA.

Approximately 4% to 6% of patients on the kidney transplant waitlist die each year. Therefore, patients may benefit from being placed on the list sooner. Benjamin J. Lee, MD (University of California, San Francisco) and his colleagues assessed the relative performance of 3 commonly used kidney function equations (termed Cockroft-Gault, MDRD, and CKD-EPI) used when placing patients on the waiting list.

The team found that the equations yield discordant results for waitlist qualification. Furthermore, choice of equation led to significant and consistent differences in qualification time when applied to 3 different patient cohorts: a group of waitlisted patients at 1 major US academic center and 2 national, multicenter study groups of CKD patients, 1 with only African Americans and the other with predominantly Caucasians. The Cockroft-Gault equation most often disadvantaged patients as compared with the MDRD and CKD-EPI equations. On average, time to waitlist qualification would be delayed on the order of 1 to 2 years by using the Cockroft-Gault equation, as compared with the MDRD equation or CKD-EPI equation.

"Given the high observed mortality rates for patients on the waitlist and median wait times of 1.4 to 3.3 years, depending on geographic location, for deceased donor transplants in the United States, the magnitude of these differences is concerning," said Dr. Lee. "The Organ Procurement and Transplantation Network may need to revise the language in kidney transplantation policies so that consistent methods to assess kidney function are adopted and patients are not inadvertently disadvantaged."

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Study: "Choice of Equation to Estimate Kidney Function Has Large Impact on Timing of Kidney Transplant Waitlist Qualification" (Abstract FR-PO1018)

Disclosures: Isabel Elaine Allen has ownership Interest in ResultCare, Ariad Pharmaceuticals, Smart Sports, IdeaPaint; and is a scientific advisor for Global Healthy Living Foundation and ResultCare. Chi-yuan Hsu receives honoraria from Satellite Healthcare and royalties from UpToDate; and is on the Satellite Healthcare Scientific Advisory Board and Medical Policy Committee.

The authors acknowledge receiving funding from NIDDK.

ASN Kidney Week 2015, the largest nephrology meeting of its kind, will provide a forum for more than 13,000 professionals to discuss the latest findings in kidney health research and engage in educational sessions related to advances in the care of patients with kidney and related disorders. Kidney Week 2015 will take place November 3-8, 2015 in San Diego, CA.

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Founded in 1966, and with nearly 16,000 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

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