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1770. Access to Kidney Transplantation in Persons Living with HIV and End-stage Renal Disease in Network 6

BACKGROUND: As persons living with HIV (PLWH) live longer, end-stage renal disease (ESRD) is emerging as a significant cause of morbidity and mortality. PLWH had a three-fold increased risk of ESRD, while also experiencing lower survival rates on dialysis compared with the general population. There...

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Autores principales: Adekunle, Ruth O, Zhang, Rebecca, Wang, Zhensheng, Patzer, Rachel, Mehta, Aneesh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6808816/
http://dx.doi.org/10.1093/ofid/ofz360.1633
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author Adekunle, Ruth O
Zhang, Rebecca
Wang, Zhensheng
Patzer, Rachel
Mehta, Aneesh
author_facet Adekunle, Ruth O
Zhang, Rebecca
Wang, Zhensheng
Patzer, Rachel
Mehta, Aneesh
author_sort Adekunle, Ruth O
collection PubMed
description BACKGROUND: As persons living with HIV (PLWH) live longer, end-stage renal disease (ESRD) is emerging as a significant cause of morbidity and mortality. PLWH had a three-fold increased risk of ESRD, while also experiencing lower survival rates on dialysis compared with the general population. There are limited data on the incidence and prevalence of PLWH on dialysis. Our objective was to determine the incidence of PLWH on dialysis in ESRD Network 6 (GA, NC, SC) and assess their referral to kidney transplantation and waitlisting on the deceased donor waiting list. METHODS: We merged data from the Southeast Transplant Referral Dataset with the United States Renal Data System Medicare Part D Prescription Claims. PLWH were defined as having a prescription for antiretroviral medications or primary cause of ESRD being HIV-associated nephropathy. Descriptive analysis was performed using Student’s t-test for continuous variables and chi-squared test for categorical variables. RESULTS: The dataset contained 24,587 patients (471 HIV positive) that initiated an ESRD service between 2012 and 2015. Incidence of PLWH on dialysis was 1.92%. Compared with HIV negative persons, PLWH were younger (median age 49 vs. 58, P < 0.001) and more often black (90% vs. 57%, P < 0.001). There were similar rates of referral among PLWH and HIV-negative persons (50% vs. 51%, P = 0.81), though PLWH were statistical significantly less likely to be waitlisted (8% vs. 15%, P < 0.001). PLWH had longer median time to be referred (240 days vs. 147 days, P < 0.001) and waitlisted compared with HIV-negative persons (611 days vs. 420 days, P = 0.04). CONCLUSION: This pilot study offers the first ESRD Network-level characterization of PLWH receiving an ESRD service proceeding through the steps of kidney transplantation. PLWH were less likely to traverse the steps of kidney transplant compared with those HIV negative, highlighting the need for targeted interventions to improve access to kidney transplant in PLWH. [Image: see text] [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-68088162019-10-28 1770. Access to Kidney Transplantation in Persons Living with HIV and End-stage Renal Disease in Network 6 Adekunle, Ruth O Zhang, Rebecca Wang, Zhensheng Patzer, Rachel Mehta, Aneesh Open Forum Infect Dis Abstracts BACKGROUND: As persons living with HIV (PLWH) live longer, end-stage renal disease (ESRD) is emerging as a significant cause of morbidity and mortality. PLWH had a three-fold increased risk of ESRD, while also experiencing lower survival rates on dialysis compared with the general population. There are limited data on the incidence and prevalence of PLWH on dialysis. Our objective was to determine the incidence of PLWH on dialysis in ESRD Network 6 (GA, NC, SC) and assess their referral to kidney transplantation and waitlisting on the deceased donor waiting list. METHODS: We merged data from the Southeast Transplant Referral Dataset with the United States Renal Data System Medicare Part D Prescription Claims. PLWH were defined as having a prescription for antiretroviral medications or primary cause of ESRD being HIV-associated nephropathy. Descriptive analysis was performed using Student’s t-test for continuous variables and chi-squared test for categorical variables. RESULTS: The dataset contained 24,587 patients (471 HIV positive) that initiated an ESRD service between 2012 and 2015. Incidence of PLWH on dialysis was 1.92%. Compared with HIV negative persons, PLWH were younger (median age 49 vs. 58, P < 0.001) and more often black (90% vs. 57%, P < 0.001). There were similar rates of referral among PLWH and HIV-negative persons (50% vs. 51%, P = 0.81), though PLWH were statistical significantly less likely to be waitlisted (8% vs. 15%, P < 0.001). PLWH had longer median time to be referred (240 days vs. 147 days, P < 0.001) and waitlisted compared with HIV-negative persons (611 days vs. 420 days, P = 0.04). CONCLUSION: This pilot study offers the first ESRD Network-level characterization of PLWH receiving an ESRD service proceeding through the steps of kidney transplantation. PLWH were less likely to traverse the steps of kidney transplant compared with those HIV negative, highlighting the need for targeted interventions to improve access to kidney transplant in PLWH. [Image: see text] [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6808816/ http://dx.doi.org/10.1093/ofid/ofz360.1633 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Adekunle, Ruth O
Zhang, Rebecca
Wang, Zhensheng
Patzer, Rachel
Mehta, Aneesh
1770. Access to Kidney Transplantation in Persons Living with HIV and End-stage Renal Disease in Network 6
title 1770. Access to Kidney Transplantation in Persons Living with HIV and End-stage Renal Disease in Network 6
title_full 1770. Access to Kidney Transplantation in Persons Living with HIV and End-stage Renal Disease in Network 6
title_fullStr 1770. Access to Kidney Transplantation in Persons Living with HIV and End-stage Renal Disease in Network 6
title_full_unstemmed 1770. Access to Kidney Transplantation in Persons Living with HIV and End-stage Renal Disease in Network 6
title_short 1770. Access to Kidney Transplantation in Persons Living with HIV and End-stage Renal Disease in Network 6
title_sort 1770. access to kidney transplantation in persons living with hiv and end-stage renal disease in network 6
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6808816/
http://dx.doi.org/10.1093/ofid/ofz360.1633
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