Kidney transplantation as primary therapy for end-stage renal disease: a National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQITM) conference.
OBJECTIVE
Kidney transplantation is the most desired and cost-effective modality of renal replacement therapy for patients with irreversible chronic kidney failure (end-stage renal disease, stage 5 chronic kidney disease). Despite emerging evidence that the best outcomes accrue to patients who receive a transplant early in the course of renal replacement therapy, only 2.5% of incident patients with end-stage renal disease undergo transplantation as their initial modality of treatment, a figure largely unchanged for at least a decade.


METHODS
The National Kidney Foundation convened a Kidney Disease Outcomes Quality Initiative (KDOQI) conference in Washington, DC, March 19 through 20, 2007, to examine the issue. Fifty-two participants representing transplant centers, dialysis providers, and payers were divided into three work groups to address the impact of early transplantation on the chronic kidney disease paradigm, educational needs of patients and professionals, and finances of renal replacement therapy.


RESULTS
Participants explored the benefits of early transplantation on costs and outcomes, identified current barriers (at multiple levels) that impede access to early transplantation, and recommended specific interventions to overcome those barriers.


CONCLUSIONS
With implementation of early education, referral to a transplant center coincident with creation of vascular access, timely transplant evaluation, and identification of potential living donors, early transplantation can be an option for substantially more patients with chronic kidney disease.
Abecassis
Michael
M
Division of Nephrology, University of Alabama at Birmingham, 625 THT, 1900 University Boulevard, Birmingham, AL 35294, USA.
Bartlett
Stephen T
ST
Collins
Allan J
AJ
Davis
Connie L
CL
Delmonico
Francis L
FL
Friedewald
John J
JJ
Hays
Rebecca
R
Howard
Andrew
A
Jones
Edward
E
Leichtman
Alan B
AB
Merion
Robert M
RM
Metzger
Robert A
RA
Pradel
Francoise
F
Schweitzer
Eugene J
EJ
Velez
Ruben L
RL
Gaston
Robert S
RS
D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care