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Published on: July 15, 2015
Barriers to pre-emptive kidney transplantation in New Zealand children
Harriet Weststrate1, Jane Ronaldson1, Georgina Yonge1
1Paediatric Nephrology Department, Starship Children's Hospital, Auckland, New Zealand.
Insights
Pre-emptive kidney transplantation (PKT) is optimal for children with kidney failure. However, late referrals and socioeconomic factors, particularly for Māori and Pasifika children, significantly reduce PKT rates in New Zealand.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Public Health
Background:
- Pre-emptive kidney transplantation (PKT) offers superior outcomes for pediatric kidney failure compared to dialysis.
- Minimizing dialysis exposure and improving graft survival are key benefits of PKT.
- Understanding current PKT rates and associated barriers is crucial for optimizing pediatric kidney care.
Purpose of the Study:
- To determine the rates of pediatric pre-emptive kidney transplantation in New Zealand.
- To identify barriers contributing to lower rates of PKT in children.
- To propose interventions for increasing future PKT rates.
Main Methods:
- Retrospective analysis of children initiating kidney replacement therapy in New Zealand (2005-2017).
- Categorization of referrals as early or late (<3 months before therapy initiation).
- Comparison of demographic and clinical characteristics between children receiving dialysis versus PKT.
Main Results:
- Only 17% (15/90) of children received a PKT.
- One-third of all pediatric patients experienced late referral.
- No children with late referrals received a PKT; younger referral age and congenital anomalies were associated with PKT.
- Māori and Pasifika children were notably absent among the pre-emptively transplanted group.
Conclusions:
- Late referral, socioeconomic deprivation, and Māori/Pasifika ethnicity are significant barriers to pediatric PKT.
- Enhanced health professional education on pediatric chronic kidney disease recognition and timely nephrology referral is essential.
- Culturally sensitive support during transplant evaluation is needed to improve equity in PKT access.
Aim:
Pre-emptive kidney transplantation (PKT) is generally considered the optimal treatment for kidney failure as it minimises dialysis-associated morbidity and mortality and is associated with improved allograft survival. This study aimed to determine rates of paediatric PKT in New Zealand, identify barriers to PKT and consider potential interventions to influence future rates of pre-emptive transplantation.
Methods:
Children commencing kidney replacement therapy between 2005 and 2017 in New Zealand were included. Descriptive analysis considered those referred late (referral <3 months prior to kidney replacement therapy initiation) or early based on referral timing to paediatric nephrology. Additional analysis compared characteristics of children receiving dialysis versus pre-emptive transplant as their first mode of kidney replacement therapy.
Results:
PKT occurred in 15 of 90 children (17%). One-third of all patients were referred late. No late referrals received a pre-emptive transplant. Pre-emptively transplanted children were referred younger (median age 0.49 years), lived in less deprived areas, were more likely to have congenital anomalies of the kidney and urinary tract and none were Māori or Pasifika ethnicity.
Conclusions:
Late referral, higher deprivation levels and Māori and Pasifika ethnicity confer a greater risk of not receiving pre-emptive transplantation. Improved education amongst health professionals about recognition of paediatric chronic kidney disease and the importance of timely referral to paediatric nephrology is recommended to reduce rates of late referral. A modified approach including enhanced culturally appropriate support for those diagnosed with chronic kidney disease during transplant evaluation should be pursued to improve equity.
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