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Offline Clark

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Improving...Care...for [Adult and] Pediatric Patients...
« on: August 03, 2022, 02:45:32 PM »

Association Between Dialysis Facility Ownership and Access to Kidney Transplantation
Jennifer C. Gander, PhD1; Xingyu Zhang, PhD2; Katherine Ross, MPH3,4; et al
JAMA. 2019;322(10):957-973. doi:10.1001/jama.2019.12803

Key Points
Question  Is dialysis facility ownership associated with access to kidney transplantation?
Findings  In this retrospective cohort study that included 1 585 947 patients with end-stage kidney disease treated at 6512 US dialysis facilities from 2000-2016, patients receiving dialysis at for-profit facilities vs nonprofit facilities had significantly lower 5-year cumulative incidence rates for placement on the deceased donor kidney transplantation waiting list (−2.6%), receipt of a living donor kidney transplant (−0.9%), and receipt of a deceased donor kidney transplant (−1.4%).
Meaning  Receiving dialysis at for-profit facilities in the United States was associated with lower kidney transplantation rates.

August 2, 2022
Improving Quality of Care and Outcomes for Pediatric Patients With End-stage Kidney Disease
The Importance of Pediatric Nephrology Expertise
Mary B. Leonard, MD, MSCE1,2; Paul C. Grimm, MD1
JAMA. 2022;328(5):427-429. doi:10.1001/jama.2022.11603

Childhood end-stage kidney disease (ESKD) is rare, accounting for approximately 1% of individuals with ESKD in the US.1 Unique features that distinguish pediatric from adult ESKD include frequent concomitant congenital anomalies, detrimental effects on all aspects of growth and development, and the need for decades of kidney replacement therapy. The beneficial effects of transplants in pediatric patients are clear. Compared with pediatric patients treated with dialysis, those who receive a transplant demonstrate better growth, neurocognitive development, academic performance, and quality of life.2 In a recent US Renal Data System (USRDS) 30-year cohort study involving 28 337 pediatric patients who initiated kidney replacement therapy before they were 18 years old, receipt of a transplant was associated with a decreased risk of all-cause death in time-varying analyses (adjusted hazard ratio

, 0.28; 95% CI, 0.16-0.48).3 Furthermore, excess mortality from ESKD has decreased markedly over decades, with the largest relative improvements seen in the youngest persons (0-14 years) with a functioning transplant.4 Accordingly, pediatric patients with ESKD are nearly universally referred for transplants.[/font][/size]


Association Between Dialysis Facility Ownership and Access to the Waiting List and Transplant in Pediatric Patients With End-stage Kidney Disease in the US
Sandra Amaral, MD, MHS1; Charles E. McCulloch, PhD2; Feng Lin, MS2; et al
JAMA. 2022;328(5):451-459. doi:10.1001/jama.2022.11231

Key Points
Question  Are there differences among pediatric patients in access to the kidney transplant waiting list or kidney transplant by profit status in US dialysis facilities?
Findings  In this retrospective cohort study from 2000-2018 involving 13 333 pediatric patients receiving dialysis at profit vs nonprofit dialysis facilities, the hazard ratio for wait-listing was 0.79 (95% CI, 0.75-0.83) and the hazard ratio for receipt of kidney transplant was 0.71 (95% CI, 0.67-0.74).
Meaning  Among US pediatric patients undergoing dialysis, profit dialysis facility status was significantly associated with increased time to wait-listing and kidney transplant.

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