Interdisciplinary care led to transplant listings for underrepresented groups with ESKD

Interdisciplinary care was associated with higher odds of being listed for kidney transplant among patients with incident end-stage kidney disease in underrepresented groups, according to this study.

Further, researchers found interdisciplinary care provides better ESKD preparedness than the usual nephrology care in this population.

“Interdisciplinary (or multidisciplinary) care improves the health of patients with chronic kidney disease but has not been well studied in patients at the highest risk for poor health outcomes,” Tanya S. Johns, MD, MHS, from the Albert Einstein College of Medicine and Montefiore Medical Center in the Bronx, New York, and colleagues wrote. “In African American and Hispanic patients with newly diagnosed kidney failure, we evaluated an interdisciplinary care program that included nurse practitioner care coordination and compared it to usual care on patient preparedness, including early access to kidney transplant listing and an optimal dialysis start.”

In a retrospective cohort study, researchers examined results for 295 patients (mean age was 59.9 years; 47% were women; 87% were African American or Hispanic) with incident ESKD at Montefiore Medical Center between Oct. 1, 2013, and Oct. 31, 2019. A total of 84 patients received interdisciplinary care, and 211 patients received usual nephrology care.

Researchers measured patient preparedness for ESKD with kidney transplant listing before dialysis initiation and optimal kidney replacement therapy (KRT) start.

Using multivariable logistic regression models adjusted for sociodemographic and clinical factors, researchers compared the odds of transplant listing and optimal KRT start between interdisciplinary and usual care groups.

Analyses revealed 44% of patients in the interdisciplinary group were listed for kidney transplants, whereas 16% of those in the usual care group were listed for transplants. Similarly, 53% of the interdisciplinary group had an optimal KRT start compared with 44% of the usual care group. After adjusting for sociodemographic and clinical factors, researchers determined interdisciplinary care correlated with a higher odds of transplant listing compared with usual care.

“Our study also highlighted the need for more optimal education surrounding living donor transplants and home modalities (such as peritoneal dialysis and home hemodialysis) because few patients received a preemptive transplant and the vast majority of patients received in-center hemodialysis,” Johns and colleagues wrote. “An interdisciplinary care approach may be superior to usual nephrology care alone among racial and ethnic minorities with advanced [chronic kidney disease] CKD; however, larger, prospective, multicenter studies are needed to determine the effectiveness of interdisciplinary care models on ESKD preparedness.”