Defining Referral for a Kidney Transplant Evaluation as a Quality Indicator: A Population-Based Cohort Study

Area of Science:

• Nephrology
• Transplant Surgery
• Health Services Research

Background:

• Kidney transplant referral is a critical first step in care, yet standardized reporting is lacking.
• Quality indicators are needed to identify and address disparities in access to kidney transplantation.
• Equitable access to kidney transplants requires robust metrics for referral processes.

Purpose of the Study:

• To examine multiple definitions of kidney transplant referral using administrative health care databases.
• To assess the impact of varying clinical inclusion criteria and follow-up definitions on referral metrics.
• To provide data for quality improvement initiatives aimed at equitable transplant access.

Main Methods:

• A population-based cohort study utilizing linked administrative health care databases in Ontario, Canada.
• Analysis of adults with advanced chronic kidney disease (CKD) between April 2017 and March 2018.
• Creation of 12 unique patient cohorts by varying eligibility criteria, health status, and cohort entry methods to calculate 1-year cumulative incidence of transplant referral.

Main Results:

• Sample sizes varied significantly across the 12 defined patient cohorts (414 to 4128).
• The 1-year cumulative incidence of kidney transplant referral showed substantial variation (e.g., 16.3% to 40.0% in the maintenance dialysis population).
• Restrictive eligibility criteria, such as excluding cardiovascular disease, led to smaller cohort sizes and higher calculated referral rates.

Conclusions:

• Administrative data definitions significantly impact measured kidney transplant referral rates.
• These findings can guide the development of quality indicators for transplant referral.
• Standardized measurement is essential to promote equitable access to kidney transplantation for all patients.