Naylor Kyla L, Kim S Joseph, Luo Bin, Wang Carol, Garg Amit X, Yohanna Seychelle, Treleaven Darin, McKenzie Susan, Ip Jane, Cooper Rebecca, Rehman Nadiyah, Knoll Gregory
ICES Western, London Health Sciences Centre Research Institute, ON, Canada.
Departments of Medicine and Epidemiology and Biostatistics, Western University, London, ON, Canada.
Can J Kidney Health Dis. 2025 Mar 21;12:20543581251317009. doi: 10.1177/20543581251317009. eCollection 2025.
Quality indicators are required to identify gaps in care and to improve equitable access to kidney transplants. Referral to a transplant center for an evaluation is the first step toward receiving a kidney transplant, yet widespread reporting on this metric is lacking.
The objective was to use administrative health care databases to examine multiple ways to define referral for a kidney transplant evaluation by varying clinical inclusion criteria, definitions for end of follow-up, and statistical methodologies.
This is a population-based cohort study.
This study linked administrative health care databases in Ontario, Canada.
Adults from Ontario, Canada, with advanced chronic kidney disease (CKD) between April 1, 2017, and March 31, 2018.
The primary outcome was the 1-year cumulative incidence of kidney transplant referral.
We created several patient cohort definitions, varying patient transplant eligibility by health status (eg, whether patients had a recorded contraindication to transplant). We presented results by advanced CKD status (ie, patients approaching the need for dialysis vs receiving maintenance dialysis) and by method of cohort entry (ie, incident only vs prevalent and incident patients combined), resulting in 12 unique cohorts.
Sample size varied substantially from 414 to 4128 depending on the patient cohort definition, with the largest reduction in cohort size occurring when we restricted to a "healthy" (eg, no evidence of cardiovascular disease) group of patients. The 1-year cumulative incidence of transplant referral varied widely across cohorts. For example, in the incident maintenance dialysis population, the cumulative incidence varied more than 2-fold from 16.3% (95% confidence interval [CI] = 15.0%-17.7%) using our most inclusive cohort definition to 40.0% (95% CI = 36.0%-44.5%) using our most restrictive "healthy" cohort of patients.
Administrative data may have misclassified individuals' eligibility for kidney transplant.
These results can be used by jurisdictions to measure transplant referral, a necessary step in kidney transplantation that is not equitable for all patients. Adoption of these indicators should drive quality improvement efforts that increase the number of patients referred for transplantation and ensure equitable access for all patient groups.
需要质量指标来识别医疗服务中的差距，并改善肾移植的公平可及性。转介至移植中心进行评估是接受肾移植的第一步，但目前缺乏关于这一指标的广泛报告。
本研究旨在利用行政医疗保健数据库，通过改变临床纳入标准、随访结束定义和统计方法，探讨多种定义肾移植评估转介的方法。
这是一项基于人群的队列研究。
本研究连接了加拿大安大略省的行政医疗保健数据库。
2017年4月1日至2018年3月31日期间来自加拿大安大略省的患有晚期慢性肾脏病（CKD）的成年人。
主要结局为肾移植转介的1年累积发病率。
我们创建了几个患者队列定义，并根据健康状况（例如，患者是否有记录在案的移植禁忌证）改变患者的移植资格。我们按晚期CKD状态（即接近需要透析的患者与接受维持性透析的患者）和队列进入方法（即仅新发病例与现患病例和新发病例合并）呈现结果，从而形成12个独特的队列。
根据患者队列定义，样本量差异很大，从414到4128不等，当我们将范围限制在“健康”（例如，无心血管疾病证据）患者组时，队列规模减少最多。各队列的1年移植转介累积发病率差异很大。例如，在新发病例的维持性透析人群中，累积发病率差异超过2倍，从使用我们最具包容性的队列定义时的16.3%（95%置信区间[CI]=15.0%-17.7%）到使用我们最严格的“健康”患者队列时的40.0%（95%CI=36.0%-44.5%）。
行政数据可能对个体的肾移植资格进行了错误分类。
这些结果可供各司法管辖区用于衡量移植转介情况，这是肾移植中的一个必要步骤，但对所有患者而言并不公平。采用这些指标应推动质量改进工作，增加转介接受移植的患者数量，并确保所有患者群体公平获得肾移植。
