Variation in Kidney Transplant Referral, Living Donor Contacts, Waitlisting, and Kidney Transplant Across Regional Renal Programs in Ontario, Canada: A Population-Based Cohort Study
Notice bibliographique
Résumé
Background: Previous studies conducted in publicly and privately funded health care systems suggest that access to kidney transplants may vary depending on where a patient receives their kidney care. It is poorly understood whether variability exists across the key steps required to receive a kidney transplant in a publicly funded health care system. Objective: To determine whether there is variation across Ontario's regional renal programs (RRPs) in key steps completed toward receiving a kidney transplant. Design: Population-based cohort study from November 1, 2017, to December 31, 2021, using linked administrative health care databases with a maximum follow-up of March 31, 2023. Setting: This study includes 27 RRPs and independent health facilities in Ontario, Canada. Patients: Patients approaching the need for dialysis and patients receiving maintenance dialysis with no recorded contraindication to kidney transplant. Measurements: Key steps toward receiving a kidney transplant, including (1) referred to a transplant center for an evaluation; (2) had a potential living donor contact a transplant center to be evaluated; (3) deceased donor waitlist activation; and (4) received a transplant from a living or deceased donor. Methods: For each step toward receiving a kidney transplant, we reported a unique incidence rate per 100 person-years with a 95% confidence interval (95% CI), presented by Ontario's RRPs, including the 27 RRPs and independent health facilities. We also presented results by 5 Ontario geographic regions. In an additional analysis, we examined the time to complete specific transplant steps. Results: We included 8319 individuals approaching the need for dialysis and 4869 individuals receiving maintenance dialysis. During follow-up, 2870 (34.5%) individuals approaching the need for dialysis initiated maintenance dialysis. In individuals approaching the need for dialysis, we found the rate of a potential living kidney donor contacting a transplant center to be evaluated varied more than 17-fold across RRPs from 0.67 (95% CI = 0.1, 4.8) to 11.7 (95% CI = 9.2, 14.9). In the dialysis cohort, the average number of steps completed toward receiving a kidney transplant varied almost 4-fold across RRPs from 11.7 (95% CI = 9.3, 14.8) to 44.0 (95% CI = 38.6, 50.1) steps per 100 person-years. The average rate of each step measured separately also varied widely, with the rate of referral to a transplant center for an evaluation (per 100 person-years) varying across RRPs from 6.0 (95% CI = 4.2, 8.5) to 47.9 (95% CI = 42.6, 53.8), the rate of a potential living kidney donor contacting a transplant center to be evaluated from 1.5 (95% CI = 0.78, 2.9) to 10.7 (95% CI = 7.9, 14.5), the rate of deceased donor waitlisting from 2.9 (95% CI = 1.9, 4.4) to 13.2 (95% CI = 11.0, 15.8), and the rate of kidney transplant from 2.0 (95% CI = 1.1, 3.4) to 12.6 (95% CI = 10.8, 14.8). When examining the results by 5 Ontario geographic regions, we found patients receiving maintenance dialysis in Northern Ontario had substantially lower rates of completing key steps toward receiving a kidney transplant. For example, the rate of transplant referral (per 100 person-years) was almost 3-fold lower in Northern Ontario (10.0, 95% CI = 8.3, 12.0) compared to Toronto (28.7, 95% CI = 25.7, 32.1). Limitations: We did not examine the reason for differences in access to kidney transplant across RRPs (eg, differences in physician practices and staff-to-patient ratio). Conclusions: Despite operating in a publicly funded health care system, there is substantial variability across the 4 key steps required to receive a kidney transplant. Trial registration: Not registered.
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Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,005 |
| Études des sciences et des technologies | 0,003 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».