Identifying the barriers and disparities for referral to kidney transplantation faced by person living with HIV and end stage renal disease Open Access

Abstract

Background:

As persons living with HIV (PLWH) live longer, end-stage renal disease (ESRD) is emerging as a significant cause of morbidity and mortality. PLWH have an increased risk of ESRD, while also experiencing lower survival rates on dialysis compared with the general population. Limited data exists on access to kidney transplantation among PLWH. We describe the early steps to kidney transplantation among PLWH on dialysis in ESRD Network 6 (GA, NC, SC) and patient and dialysis facility level characteristics that serve as barriers to transplantation.

Methods:

A novel dataset inclusive of incident dialysis patients between 2012 and 2016 that identifies PLWH and the general dialysis population of ESRD Network 6, was created through merging the United States Renal Data System with the Southeast Transplant Referral Dataset. Through use of Medicare Part D Prescription Claims data, PLWH on dialysis in ESRD Network 6 were identified. Descriptive analysis was performed comparing early steps of transplantation among PLWH to the general dialysis population. Additional analysis included cumulative incidence function and cox regression models for time to event analysis.

Results:

There were 30,221 incident dialysis patients (571 HIV positive) between 2012 and 2016. PLWH were younger (median age 49 vs 58, P-value<0.001), predominantly black (87% vs 57%, P-value<0.001) and male (69% vs 56%, P-value<0.001). PLWH and HIV negative persons were referred and evaluated to kidney transplantation at similar proportions, though PLWH were significantly less likely to be waitlisted (5% vs 11%, P-value<0.001). Longer median time to referral, evaluation and waitlisting was observed for PLWH. HIV serostatus, BMI ≥ 35 (kg/m2), cardiovascular related co-morbidities, lack of nephrology care prior to dialysis start, poverty, and limited full-time social work staff members were barriers to either referral or waitlisting.

Conclusions:

This pilot study offers the first regional-level characterization of PLWH proceeding through the early steps of transplantation. PLWH were less likely to traverse the steps of kidney transplant compared with those HIV negative, highlighting the need for targeted interventions to improve access to kidney transplant for PLWH.

Table of Contents

TABLE OF CONTENTS

INTRODUCTION

BACKGROUND

METHODS

RESULTS

DISCUSSION

CONCLUSIONS

REFERENCES

About this Master's Thesis

Rights statement

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School	Laney Graduate School
Department	Clinical Research
Degree	M.S.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Medicine and Surgery
Keyword	End-Stage Renal Disease Disparities HIV Transplantation
Committee Chair / Thesis Advisor	Amita Manatunga, Emory University
Committee Members	Rachel Patzer, Emory University Aneesh Mehta, Emory University

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