Medical and non-medical determinants of access to renal transplant waiting list in a French community-based network of care.
BACKGROUND
Evaluation of adult candidates for kidney transplantation diverges from one centre to another. Concurrently, ethnic background, female gender, late referral to a nephrologist, distance from transplantation department and private ownership of a dialysis facility have been associated with poor access to kidney transplantation. We assessed determinants of access to a waiting list in a French community-based network of care.


METHODS
From July 1997 to June 2003, 1725 adults living in Lorraine, who started renal replacement therapy in one of the 13 facilities of the network, were included. We compared, first, the patients registered on the waiting list with those not registered and, second, the patients registered before starting dialysis with those registered after.


RESULTS
Using logistic regression, registration on the waiting list was exclusively associated with age and medical factors, except for one variable: medical follow-up in the department performing transplantation [odds ratio (OR): 1.67 (95%CI: 1.05-2.67)]. Registration before starting dialysis was not associated with medical factors but with age [OR of patients younger than 45 years vs those older than 65 years: 3.85 (95%CI: 1.05-24.92)] and medical follow-up in the department performing transplantation [OR: 3.56 (95%CI: 1.98-6.67)].


CONCLUSIONS
In a French community-based network, patients followed by the nephrology department performing transplantation are more likely to be registered on the transplant waiting list early in the course of chronic kidney disease. Age over 55 per se is a considerable barrier to access to kidney transplantation. Medical guidelines should allow a standardization of criteria for registration.
Bayat
Sahar
S
Service de néphrologie, Hôpitaux de Brabois, 54500 Vandoeuvre les Nancy, France.
Frimat
Luc
L
Thilly
Nathalie
N
Loos
Carole
C
Briançon
Serge
S
Kessler
Michèle
M
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D019058:Community Networks / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D006435:Renal Dialysis; D014850:Waiting Lists