Impact of Quality Indicators on Transplant Access: A Prospective Cohort Study in Australian Dialysis Patients

In 2012, the Australian state of Victoria introduced a 6-monthly reportable renal quality indicator (QI) for the proportion of patient's waitlisted or pre-emptively transplanted by set time points after beginning kidney replacement therapy (KRT). This prospective cohort study aimed to determine if the QI influenced timeliness of transplant waitlisting for Victorians, compared to the rest of Australia as a control group.

Patients aged 18-70 commencing KRT between 2007 and 2020 were extracted from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) and divided into three time eras. The primary outcome was the percentage of patients waitlisted or transplanted at 6, 12 and 24 months from starting KRT. Given the systematic disadvantage reported, specific analysis was performed to examine the QI's effect on Aboriginal and Torres Strait Islander people living in Victoria.

Of 25 836 (14.7% Indigenous) patients starting dialysis, one third (8587, 5.7% Indigenous) were listed for transplant. Following implementation of the QI, the proportion of Victorian patients waitlisted within 6, 12 and 24-months of starting KRT increased (adjusted OR [aOR] 1.85, 1.67 and 1.55 respectively; all p < 0.001). There was no significant change in Australian (non-Victorian) rates at 6 and 12 months but a small increase was observed at 24 months.

Following introduction of the Victorian renal QI, the proportion of Victorian patients waitlisted at key timepoints improved more than patients in Australian states without QIs.