Table 2.
Patient Characteristics and Crude Hierarchical Cox Proportional Hazard Ratios (HRs) Among Patients Who Were Placed on the Deceased Donor Waiting List, Received a Living Donor Kidney Transplant, or Received a Deceased Donor Kidney Transplant During Follow-up, 2000–2016
| Characteristicsa | Censored Date (n = 1 341 386)b |
Placement on the Deceased Donor Waiting List (n = 121 680) (8.2%) |
Receipt of a Living Donor Kidney Transplant (n = 23 762) (1.6%) |
Receipt of a Deceased Donor Kidney Transplant (n = 49 290) (3.3%) |
|||
|---|---|---|---|---|---|---|---|
| No. (%) | No. (%) | HR (95% Cl)c | No. (%) | HR (95% Cl)d | No. (%) | HR (95% Cl)e | |
| Dialysis Facility Ownershipf | |||||||
| Nonprofit | |||||||
| Small chains (n = 109 030) | 94 601 (86.8) | 12 942 (11.9) | 1 [Reference] | 2694(2.5) | 1 [Reference] | 5337 (4.9) | 1 [Reference] |
| Independent facilities (n = 78 287) | 53 992 (69.0) | 23 324(29.8) | 2.74 (2.68–2.80) | 3914(5.0) | 1.90 (1.81–2.00) | 8899 (11.4) | 2.07 (2.00–2.14) |
| For-Profit | |||||||
| Large chain 1 (n = 483 988) | 444 858 (91.2) | 34027 (7.0) | 0.58 (0.57–0.59) | 6719(1.4) | 0.57 (0.54–0.60) | 14006 (2.9) | 0.60 (0.58–0.62) |
| Large chain 2 (n = 482 689) | 447 759 (92.8) | 29812 (6.2) | 0.52 (0.51–0.53) | 6403 (1.3) | 0.55 (0.53–0.58) | 12 652 (2.6) | 0.56 (0.54–0.58) |
| Small chains (n = 225 890) | 209 161 (92.6) | 14815 (6.6) | 0.55 (0.54–0.57) | 2674(1.2) | 0.49 (0.47–0.52) | 5926 (2.6) | 0.56 (0.54–0.58) |
| Independent facilities (n = 98 680) | 91 105 (92.2) | 6760 (6.9) | 0.59 (0.57–0.61) | 1358 (1.4) | 0.59 (0.55–0.62) | 2470 (2.5) | 0.54(0.52–0.57) |
| All facilities | |||||||
| Nonprofit (n = 187 317) | 148 593 (79.3) | 36 266 (19.4) | 1 [Reference] | 6608 (3.5) | 1 [Reference] | 14236 (7.6) | 1 [Reference] |
| For-profit (n = 1 291 247) | 1 192 793 (92.4) | 85 414(6.6) | 0.33 (0.32–0.33) | 17154(1.3) | 0.40 (0.39–0.41) | 35 054(2.7) | 0.39 (0.38–0.40) |
| Patient-Level Characteristics at Start of Dialysisa | |||||||
| Age group, y | |||||||
| 18–29 | 18 152 (57.2) | 11 251 (35.4) | 4.21 (4.12–4.30) | 4206 (13.2) | 10.8(10.3–11.3) | 5709 (18.0) | 5.48 (5.30–5.68) |
| 30–39 | 46 118 (68.6) | 16 840 (25.1) | 2.94 (2.88–2.99) | 4280(6.4) | 5.24(5.01–5.47) | 9699(14.4) | 4.53 (4.40–4.67) |
| 40–49 | 111 700 (77.9) | 27361 (19.1) | 2.31 (2.27–2.35) | 5301 (3.7) | 3.09 (2.96–3.22) | 12 296 (8.6) | 2.86 (2.78–2.94) |
| 50–59 | 230 534 (85.7) | 35491 (13.2) | 1.70 (1.68–1.73) | 5535 (2.1) | 1.83 (1.76–1.91) | 12 694 (4.7) | 1.84(1.78–1.89) |
| 60–69 | 337 535 (92.5) | 25 839 (7.1) | 1 [Reference] | 3679 (1.0) | 1 [Reference] | 7557 (2.1) | 1 [Reference] |
| ≥70 | 597 347 (99.1) | 4898 (0.8) | 0.14(0.13–0.14) | 761 (0.1) | 0.15 (0.14–0.17) | 1335 (0.2) | 0.16(0.15–0.17) |
| Sex | |||||||
| Male | 733 434 (89.7) | 75 081 (9.2) | 1 [Reference] | 14 792 (1.8) | 1 [Reference] | 30510 (3.7) | 1 [Reference] |
| Female | 607 952 (92.0) | 46 599 (7.1) | 0.75 (0.74–0.76) | 8970 (1.4) | 0.74(0.72–0.76) | 18 780 (2.8) | 0.73 (0.72–0.74) |
| Race/ethnicity | |||||||
| Non-Hispanic white | 74 4464 (92.4) | 51 267 (6.4) | 1 [Reference] | 14 763 (1.8) | 1 [Reference] | 22 036 (2.7) | 1 [Reference] |
| Non-Hispanic black | 373 135 (89.8) | 39 641 (9.5) | 1.53 (1.50–1.55) | 4044(1.0) | 0.85 (0.82–0.88) | 16195(3.9) | 0.96 (0.93–0.98) |
| Hispanic white | 155 183 (86.8) | 21491 (12.0) | 1.21 (1.19–1.23) | 3572 (2.0) | 0.42 (0.40–0.43) | 7582 (4.2) | 0.88 (0.86–0.90) |
| Otherg | 68 604 (87.3) | 9281 (11.8) | 1.57 (1.54–1.61) | 1383 (1.8) | 0.78 (0.73–0.82) | 3477(4.4) | 1.08 (1.04–1.12) |
| Insurance coverageh | |||||||
| Medicare | 524 311 (96.6) | 171 25(3.2) | 0.20 (0.20–0.21) | 2456 (0.5) | 0.11 (0.11–0.12) | 5472 (1.0) | 0.19(0.18–0.19) |
| Medicaid | 35 0489 (92.8) | 24 333 (6.4) | 0.37 (0.37–0.38) | 2998 (0.8) | 0.18(0.18–0.19) | 9495 (2.5) | 0.35 (0.34–0.36) |
| Employer | 188 766 (78.8) | 43 833 (18.3) | 1 [Reference] | 11764 (4.9) | 1 [Reference] | 19 349 (8.1) | 1 [Reference] |
| None | 84 277 (81.6) | 17 283 (16.7) | 0.74 (0.72–0.75) | 2554(2.5) | 0.41 (0.40–0.43) | 7800 (7.6) | 0.63 (0.62–0.65) |
| Otheri | 84 717 (85.1) | 13 069 (13.2) | 0.71 (0.69–0.72) | 3070 (3.1) | 0.63 (0.61–0.66) | 5366 (5.4) | 0.66 (0.64–0.68) |
| Attributed cause of ESKD | |||||||
| Diabetes | 636 630 (91.7) | 48 240 (6.9) | 1 [Reference] | 7028 (1.0) | 1 [Reference] | 20 670 (3.0) | 1 [Reference] |
| Hypertension | 407 538 (92.7) | 30 133 (6.9) | 1.02 (1.01–1.04) | 4486(1.0) | 1.04(1.00–1.08) | 11 383 (2.6) | 0.85 (0.83–0.87) |
| Other disease | 215 645 (91.1) | 192 83 (8.1) | 1.26 (1.24–1.28) | 4940(2.1) | 2.22 (2.14–2.30) | 7631 (3.2) | 1.01 (0.99–1.04) |
| Glomerulonephritis | 81 573 (75.6) | 24 024(22.3) | 3.00 (2.96–3.05) | 7308 (6.8) | 5.95 (5.76–6.15) | 9606 (8.9) | 2.17(2.12–2.22) |
| Dialysis typeJ | |||||||
| In-center hemodialysis | 1 235 615 (92.2) | 92 673 (6.9) | 1 [Reference] | 16 947 (1.3) | 1 [Reference] | 37627 (2.8) | 1 [Reference] |
| Peritoneal dialysis | 80 218 (73.7) | 25 352 (23.3) | 3.86 (3.81–3.92) | 5983 (5.5) | 4.58(4.45–4.72) | 10118(9.3) | 4.53 (4.44–4.64) |
| Home hemodialysis | 179 01 (82.1) | 3612 (16.6) | 2.39 (2.31–2.47) | 772 (3.5) | 2.67 (2.48–2.87) | 1456 (6.7) | 2.25 (2.13–2.37) |
| Patient-Level Comorbidities at Start of Dialysis and Measures of Access to Transplantationa | |||||||
| Hypertension | 1 130 062 (90.6) | 104 489(8.4) | 1.07 (1.05–1.09) | 19403 (1.6) | 0.77 (0.74–0.79) | 42 009 (3.4) | 1.06 (1.03–1.09) |
| Diabetes | 655 158 (92.2) | 46 622 (6.6) | 0.70 (0.70–0.71) | 6413 (0.9) | 0.42 (0.41–0.43) | 18 896 (2.7) | 0.85 (0.84–0.87) |
| Congestive heart failure | 470 977 (96.0) | 18107(3.7) | 0.42 (0.41–0.42) | 2451 (0.5) | 0.28 (0.27–0.29) | 5888 (1.2) | 0.39 (0.38–0.40) |
| BMI>35k | 252 850 (91.7) | 21 749 (7.9) | 0.87 (0.86–0.88) | 3177(1.2) | 0.61 (0.59–0.64) | 7049 (2.6) | 0.63 (0.61–0.65) |
| Other cardiac disease | 199 097 (96.3) | 7126(3.4) | 0.49 (0.47–0.5) | 945 (0.5) | 0.32 (0.30–0.35) | 1988 (1.0) | 0.44(0.42–0.46) |
| Atherosclerotic heart disease | 197 145 (96.0) | 7575 (3.7) | 0.47 (0.46–0.49) | 1032 (0.5) | 0.32 (0.31–0.35) | 2075 (1.0) | 0.39 (0.37–0.41) |
| Peripheral vascular disease | 191 483 (96.3) | 6485 (3.3) | 0.41 (0.40–0.42) | 934(0.5) | 0.30 (0.28–0.32) | 2092 (1.1) | 0.39 (0.37–0.40) |
| Cerebrovascular disease | 138 017 (96.3) | 4878(3.4) | 0.44 (0.42–0.45) | 642 (0.4) | 0.29 (0.27–0.32) | 1602 (1.1) | 0.41 (0.39–0.43) |
| COPD | 139 765 (98.0) | 2630 (1.8) | 0.26 (0.25–0.27) | 400 (0.3) | 0.21 (0.19–0.23) | 792 (0.6) | 0.25 (0.24–0.27) |
| Cancer | 106 370 (97.0) | 3064(2.8) | 0.41 (0.40–0.43) | 641 (0.6) | 0.45 (0.42–0.49) | 946 (0.9) | 0.38 (0.35–0.40) |
| Tobacco use | 85 877 (93.0) | 5734(6.2) | 0.72 (0.70–0.74) | 1008 (1.1) | 0.65 (0.61–0.69) | 2304(2.5) | 0.73 (0.70–0.76) |
| Nephrology care before ESKDl | 563 625 (90.5) | 53 496 (8.6) | 1.00 (0.99–1.02) | 8777 (1.4) | 1.18(1.15–1.22) | 19148 (3.1) | 1.11 (1.08–1.13) |
| Not Informed of transplant options due to medical reasonsm | 79 280 (99.0) | 777 (1.0) | 0.16 (0.15–0.17) | 87(0.1) | 0.09 (0.08–0.12) | 218(0.3) | 0.15 (0.13–0.17) |
| Dialysis Facility-Level Characteristics | |||||||
| ESRD Network geographic areasn | |||||||
| Northeasto | 214 813 (90.0) | 21 864(9.1) | 1 [Reference] | 21 684(9.1) | 1 [Reference] | 8115 (3.4) | 1 [Reference] |
| Southp | 554 157 (91.1) | 48 866 (8.0) | 0.83 (0.82–0.84) | 48 866 (8.0) | 0.67 (0.65–0.70) | 20 171(3.3) | 0.90 (0.88–0.92) |
| Midwestq | 303 183 (90.8) | 25 581 (7.7) | 0.82 (0.8–0.83) | 25 581 (7.7) | 1.21 (1.16–1.26) | 11 664 (3.5) | 1.04(1.01–1.07) |
| Westr | 269 233 (90.3) | 25 549 (8.6) | 0.87 (0.86–0.89) | 25 549 (8.6) | 0.84(0.81–0.88) | 9340 (3.1) | 0.82 (0.79–0.84) |
| Metropolitan rural-urban classifications | |||||||
| Metropolitan area | 1 115 432 (83.9) | 104 943 (8.5) | 1 [Reference] | 20 002 (1.6) | 1 [Reference] | 42 315 (3.4) | 1 [Reference] |
| Rural area | 213 870 (16.1) | 15 626 (6.7) | 0.81 (0.74–0.88) | 3539 (1.5) | 0.97 (0.90–1.05) | 6540 (2.8) | 0.89 (0.82–0.96) |
| Distance from assigned facility to nearest transplant center, median (IQR), mt | 16.7 (6.1–53.2) | 9.0 (2.1–36.1) | 1.00 (1.00–1.00) | 9.9 (2.2–38.3) | 1.00 (1.00–1.00) | 9.0 (2.4–35.3) | 1.00 (1.00–1.00) |
Abbreviations: BMI, body mass index; C0PD chronic obstructive pulmonary disease; ESKD, end-stage kidney disease; ESRD, end-stage renal disease; IQR, interquartile range.
Baseline characteristics were obtained at the time the CMS-2728 form was completed.
Defined as death or end of follow-up (December 31,2016).
Univariate Cox proportional hazard model determined the association between patient- and facility-level characteristics and placement on the deceased donor waiting list. Time to follow-up was defined as start of dialysis to placement on waiting list or censor date (end of study or death).
Univariate Cox proportional hazard model determined the association between patient- and facility-level characteristics and receipt of a living donor kidney transplant. Time to follow-up was defined as start of dialysis to living donor kidney transplant or censor date (end of study or death).
Univariate Cox proportional hazard model determined the association between patient- and facility-level characteristics receipt of a deceased donor kidney transplant. Time to follow-up was defined as start of dialysis to deceased donor kidney transplant or censor date (end of study or death).
Patients were assigned to the last dialysis facility from which they were receiving treatment when the outcome event of interest occurred.
Defined as Asian, Middle Eastern, Native American, Pacific Islander, or multiracial.
There were missing data for 115 322 patients (7.8%).
This category was collected and defined on the CMS-2728 form and was not further defined.
There were missing data for 7805 patients (0.5%).
Calculated as weight in kilograms divided by height in meters squared.
There were missing data for 546 900 patients (37.0%).
Obtained from item 27 on the CMS-2728 form. The attending physician recorded no if the patient had not been informed of their transplant options and entered all the reasons why a kidney transplant was not an option for the patient at that time.
Obtained from the Dialysis Facility Report, 2013–2016.
Network 1: Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, and Vermont; NetworK 2: New York; Network 3: New Jersey; and Network4: Delaware and Pennsylvania.
Network 5: District of Columbia, Maryland, Virginia, and West Virginia; Network 6: Georgia, North Carolina, and South Carolina; Network7: Florida; Network 8: Alabama, Mississippi, and Tennessee; Network 13: Arkansas, Louisiana, and Oklahoma; and Network 14: Texas.
NetworK 9/10: Illinois, Indiana, Kentucky, and Ohio; Network 11: Michigan, Minnesota, North Dakota, South Dakota, and Wisconsin; and Network 12: Iowa, Kansas, Missouri, and Nebraska.
Network 15: Arizona, Colorado, Nevada, New Mexico, Utah, and Wyoming; Network 16: Alaska, Idaho, Montana, Oregon, and Washington; Network 17: Hawaii and northern California; and Network 18: southern California.
Obtained from the US Department of Agriculture Rural and Urban Continuum Code. There were missing data for 13 322 patients (0.9%).
Calculated using the dialysis facility address from Dialysis Facility Compare (2013–2016) and the nearest transplant center address from the Scientific Registry of Transplant Recipients. There were missing data for 319177 patients (21.6%).