Kidney transplantation and wait-listing rates from the international Dialysis Outcomes and Practice Patterns Study (DOPPS).
BACKGROUND
The international Dialysis Outcomes and Practice Patterns Study (DOPPS I and II) allows description of variations in kidney transplantation and wait-listing from nationally representative samples of 18- to 65-year-old hemodialysis patients. The present study examines the health status and socioeconomic characteristics of United States patients, the role of for-profit versus not-for-profit status of dialysis facilities, and the likelihood of transplant wait-listing and transplantation rates.


METHODS
Analyses of transplantation rates were based on 5267 randomly selected DOPPS I patients in dialysis units in the United States, Europe, and Japan who received chronic hemodialysis therapy for at least 90 days in 2000. Left-truncated Cox regression was used to assess time to kidney transplantation. Logistic regression determined the odds of being transplant wait-listed for a cross-section of 1323 hemodialysis patients in the United States in 2000. Furthermore, kidney transplant wait-listing was determined in 12 countries from cross-sectional samples of DOPPS II hemodialysis patients in 2002 to 2003 (N= 4274).


RESULTS
Transplantation rates varied widely, from very low in Japan to 25-fold higher in the United States and 75-fold higher in Spain (both P values <0.0001). Factors associated with higher rates of transplantation included younger age, nonblack race, less comorbidity, fewer years on dialysis, higher income, and higher education levels. The likelihood of being wait-listed showed wide variation internationally and by United States region but not by for-profit dialysis unit status within the United States.


CONCLUSIONS
DOPPS I and II confirmed large variations in kidney transplantation rates by country, even after adjusting for differences in case mix. Facility size and, in the United States, profit status, were not associated with varying transplantation rates. International results consistently showed higher transplantation rates for younger, healthier, better-educated, and higher income patients.
Satayathum
Suditida
S
University Renal Research and Education Association, Ann Arbor, Michigan 48103, USA.
Pisoni
Ronald L
RL
McCullough
Keith P
KP
Merion
Robert M
RM
Wikström
Bjorn
B
Levin
Nathan
N
Chen
Kenneth
K
Wolfe
Robert A
RA
Goodkin
David A
DA
Piera
Luis
L
Asano
Yasushi
Y
Kurokawa
Kiyoshi
K
Fukuhara
Shunichi
S
Held
Philip J
PJ
Port
Friedrich K
FK
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D005060:Europe / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006304:Health Status; D006436:Hemodialysis Units, Hospital / Q000706:statistics & numerical data; D006777:Hospitals, Proprietary / Q000706:statistics & numerical data; D006788:Hospitals, Voluntary / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000453:epidemiology* / Q000601:surgery / Q000628:therapy; D016030:Kidney Transplantation / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D044469:Racial Groups / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000191:economics / Q000706:statistics & numerical data*; D012923:Social Class; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists