Regional Variation in Referral Rates for Kidney Transplantation Among Incident Canadian Dialysis Patients.

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BACKGROUND: Data comparing regional referral rates for kidney transplantation from dialysis centers across Canada have not been previously reported. METHODS: The Canadian Organ Replacement Register Access to Kidney Transplantation Feasibility Study is a national prospective cohort study of incident dialysis patients referred for kidney transplantation from 1 Jun 2010 to 31 May 2013. All provinces were included except Quebec, since data on incident dialysis patients from the latter were incomplete in recent years. Rates of referral were calculated using the person-time method and the relative hazard for referral was examined using Cox proportional hazards models. RESULTS: A total of 1,450 of 9,102 incident dialysis patients (15.3%) were referred for kidney transplantation during the study period. Referral rates ranged from 7.0 (95% CI: 4.1, 9.9) to 27.5 (95% CI: 23.2, 31.8) per 100 patient-years (Table 1). Using Ontario as the referent, the relative hazard for referral varied from 0.48 (95% CI: 0.37, 0.62) to 2.00 (95% CI: 1.68, 2.38). After adjustment for age at dialysis initiation, sex, race, and cause of ESRD, the relative hazards ranged from 0.56 (95% CI: 0.37, 0.86) to 1.63 (95% CI: 1.36, 1.95) (Table 1). CONCLUSIONS: Rates of referral for kidney transplantation vary 3 to 4-fold across Canada. An evaluation of patient, provider, and center-level determinants of the observed variation in referral rates will require further study.Table: No Caption available.DISCLOSURES:Kim, S.: Grant/Research Support, Astellas Pharma Canada, Novartis Pharma Canada, Genzyme Pharma Canada.

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