title: Variation in Access to Kidney Transplantation Across Renal Programs in Ontario, Canada.
abstract: In the United States, kidney transplant rates vary significantly across end-stage renal disease (ESRD) networks. We conducted a population-based cohort study to determine whether there was variability in kidney transplant rates across renal programs in a health care system distinct from the United States. We included incident chronic dialysis patients in Ontario, Canada, from 2003 to 2013 and determined the 1-, 5-, and 10-year cumulative incidence of kidney transplantation in 27 regional renal programs (similar to U.S. ESRD networks). We also assessed the cumulative incidence of kidney transplant for "healthy" dialysis patients (aged 18-50 years without diabetes, coronary disease, or malignancy). We calculated standardized transplant ratios (STRs) using a Cox proportional hazards model, adjusting for patient characteristics (maximum possible follow-up of 11 years). Among 23 022 chronic dialysis patients, the 10-year cumulative incidence of kidney transplantation ranged from 7.4% (95% confidence interval [CI] 4.8-10.7%) to 31.4% (95% CI 16.5-47.5%) across renal programs. Similar variability was observed in our healthy cohort. STRs ranged from 0.3 (95% CI 0.2-0.5) to 1.5 (95% CI 1.4-1.7) across renal programs. There was significant variation in kidney transplant rates across Ontario renal programs despite patients having access to the same publicly funded health care system.
authors.affiliation: Institute for Clinical Evaluative Sciences (ICES), London, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: K L
authors.initials: KL
authors.lastname: Naylor
authors.affiliation: Institute for Clinical Evaluative Sciences (ICES), London, Ontario, Canada.|Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada.
authors.forename: S N
authors.initials: SN
authors.lastname: Dixon
authors.affiliation: Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada.|Division of Nephrology, Western University, London, Ontario, Canada.
authors.forename: A X
authors.initials: AX
authors.lastname: Garg
authors.affiliation: Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: S J
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Division of Nephrology, Western University, London, Ontario, Canada.
authors.forename: P G
authors.initials: PG
authors.lastname: Blake
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|Nephrology Program, Humber River Hospital, Toronto, Ontario, Canada.
authors.forename: G E
authors.initials: GE
authors.lastname: Nesrallah
authors.affiliation: Institute for Clinical Evaluative Sciences (ICES), London, Ontario, Canada.
authors.forename: M K
authors.initials: MK
authors.lastname: McCallum
authors.affiliation: Ontario Renal Network, Toronto, Ontario, Canada.
authors.forename: C
authors.initials: C
authors.lastname: D'Antonio
authors.affiliation: Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada.|Division of Nephrology, Western University, London, Ontario, Canada.
authors.forename: A H
authors.initials: AH
authors.lastname: Li
authors.affiliation: Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: G A
authors.initials: GA
authors.lastname: Knoll
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009864:Ontario; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data*; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: clinical research/practice; epidemiology; kidney transplantation/nephrology; quality of care/care delivery