Disparities in Kidney Transplant Waitlisting, with Syed Ali Husain, MD, MPH

Disparities based on sex, race, ethnicity, and employment status may play a role in the kidney transplant waitlisting process, as highlighted by findings from a recent retrospective cohort study of ≥50,000 patients with end-stage kidney disease on dialysis.¹

Using data from the US Renal Data System Registry, investigators identified 52,902 patients aged ≤40 years with no major medical comorbidities who initiated dialysis between January 1, 2005, and December 31, 2019, and examined time to waitlisting for a kidney transplant. Investigators categorized patients into 3 groups based on outcome: waitlisted <1 year after dialysis initiation, waitlisted 1-5 years after dialysis initiation, or not waitlisted within 5 years of dialysis initiation.¹

In total, 15,840 (30%) patients were waitlisted within 1 year, 11,122 (21%) between 1-5 years, and 25,940 (49%) patients were not waitlisted within 5 years of dialysis initiation. Investigators noted sex and age impacted waitlisting, with increased age (subhazard ratio [SHR], .98 per year; 95% confidence interval [CI], .97 to .98; P < .001) and female sex (SHR, .92; 95% CI, .90 to .94; P <.001) associated with decreased waitlisting. Hispanic ethnicity (SHR, .77; 95% CI, .75 to .80; P < .001), Black race (SHR, .66; 95% CI, .64 to .68; P < .001), and unemployment (SHR, .47; 95% CI, .45 to .48; P < .001) were also associated with reduced waitlisting.¹

The editorial team of HCPLive Nephrology sat down with primary investigator Syed Ali Husain, MD, MPH, assistant professor of medicine at Columbia University Medical Center, for more insight into chronic kidney disease, study results, and how waitlisting disparities can be improved moving forward.