Early Access to Kidney Transplantation among Patients with Lupus Nephritis

狼疮性肾炎患者早期接受肾移植

• 批准号: 10679787
• 负责人: Laura McPherson
• 金额: $ 4.77万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10679787
• 关键词: Adult; Affect; Age; Allografting; Autoimmune Diseases; Cessation of life; Characteristics; Chronic; Chronic Disease; Classification; Communication; Communities; Complex; Cox Proportional Hazards Models; Data; Data Reporting; Databases; Development; Diagnosis; Dialysis procedure; Eligibility Determination; End stage renal failure; Ensure; Epidemiology; Ethnic Origin; Evaluation; Female; Gender; Geographic Locations; Goals; Health Services Research; Health system; Healthcare Systems; Hemodialysis; Improve Access; Individual; Inflammation; Information Systems; Intervention; Kidney; Kidney Failure; Kidney Transplantation; Knowledge; Life; Link; Literature; Logistics; Lupus; Lupus Nephritis; Maintenance; Mediating; Medical; Mentors; Neighborhoods; Organ; Outcome; Patient Care; Patients; Persons; Population; Poverty; Prevalence; Process; Provider; Race; Registries; Reporting; Research; Research Personnel; Research Project Grants; Research Proposals; Residual state; Retrospective cohort; Specialist; System; Systemic Lupus Erythematosus; Time; Transplantation; United States; Visit; Waiting Lists; care coordination; career; chronic autoimmune disease; clinical practice; health inequalities; high risk; improved; improved outcome; insight; low socioeconomic status; minority patient; multilevel analysis; national surveillance; novel; patient population; post-transplant; premature; primary care provider; racial minority; residence; skills; socioeconomics; surveillance data; transplant centers; Adult; Affect; Age; Allografting; Autoimmune Diseases; Cessation of life; Characteristics; Chronic; Chronic Disease; Classification; Communication; Communities; Complex; Cox Proportional Hazards Models; Data; Data Reporting; Databases; Development; Diagnosis; Dialysis procedure; Eligibility Determination; End stage renal failure; Ensure; Epidemiology; Ethnic Origin; Evaluation; Female; Gender; Geographic Locations; Goals; Health Services Research; Health system; Healthcare Systems; Hemodialysis; Improve Access; Individual; Inflammation; Information Systems; Intervention; Kidney; Kidney Failure; Kidney Transplantation; Knowledge; Life; Link; Literature; Logistics; Lupus; Lupus Nephritis; Maintenance; Mediating; Medical; Mentors; Neighborhoods; Organ; Outcome; Patient Care; Patients; Persons; Population; Poverty; Prevalence; Process; Provider; Race; Registries; Reporting; Research; Research Personnel; Research Project Grants; Research Proposals; Residual state; Retrospective cohort; Specialist; System; Systemic Lupus Erythematosus; Time; Transplantation; United States; Visit; Waiting Lists; care coordination; career; chronic autoimmune disease; clinical practice; health inequalities; high risk; improved; improved outcome; insight; low socioeconomic status; minority patient; multilevel analysis; national surveillance; novel; patient population; post-transplant; premature; primary care provider; racial minority; residence; skills; socioeconomics; surveillance data; transplant centers

PROJECT SUMMARY Systemic lupus erythematosus (SLE) is a chronic, multisystem autoimmune disease that can result in a serious renal manifestation known as lupus nephritis (LN) and eventually, LN-associated end-stage kidney disease (LN-ESKD). The development of LN-ESKD among patients with SLE is of particular concern due to its high risk of premature death and its disproportionate impact on younger patients and patients of minority race and lower socioeconomic status. There are only two treatment options for patients with LN-ESKD, and research suggests that kidney transplantation provides a greater survival benefit compared to long-term dialysis. Despite this, the majority of LN-ESKD patients are initiated on dialysis and it is largely unknown how soon after progression to ESKD that the kidney transplant process is initiated and what socioeconomic and health system barriers may hinder this treatment transition in this population. The kidney transplant process is complex for patients and requires coordinated communication across multiple providers and health systems, including primary care providers, nephrologists, dialysis facilities, and transplant centers. The overarching goal of this research proposal is to characterize early access to kidney transplantation among adult (≥18 years) patients with LN- ESKD in the U.S. by evaluating the impact of socioeconomic and health systems processes on the first step in the kidney transplant process, referral for an evaluation at a transplant center. This research will leverage national surveillance data of ESKD patients from the United States Renal Data System (USRDS) linked with novel patient referral information from the Early Transplant Access Registry that is not collected in national or regional surveillance systems to examine this critical and necessary first step to accessing a transplant. Aim 1 will estimate the timing of 1) kidney transplant referral from ESKD start comparing LN-ESKD patients to patients with ESKD unrelated to LN, using Cox proportional hazards models. Aim 2 will evaluate the association between neighborhood poverty and referral for kidney transplant in patients with LN-ESKD and the potential mediating effect of visiting a kidney specialist prior to ESKD start. Aim 3 will use cross-classified logistic multilevel models to determine the influence of health system factors (including dialysis facility and transplant center characteristics) on referral for kidney transplant in patients with ESKD. The results from this proposed research project will provide insight into the epidemiology of referral for kidney transplant in LN- ESKD patients. Furthermore, it will inform clinical practice among clinicians treating patients with LN-ESKD by emphasizing the importance of timely referral for kidney transplant to reduce patients’ time spent on dialysis and death from other causes while on the waitlist. These results will also inform development of targeted interventions to improve access to a nephrologist prior to progressing into ESKD and to enhance patient care coordination across healthcare systems between dialysis facilities and transplant centers.

项目摘要 全身性红斑狼疮（SLE）是一种慢性多系统自身免疫性疾病，可能导致严重 肾脏表现形式称为狼疮肾炎（LN），有时是与LN相关的末期肾脏疾病 （LN-ESKD）。由于其高风险，LN-ESKD在SLE患者中的发展特别关注 过早死亡及其对年轻患者和少数族裔患者和较低的患者的影响不成比例 社会经济地位。 LN-ESKD患者只有两种治疗选择，研究表明 与长期透析相比，该肾脏移植具有更大的生存优势。尽管如此， 大多数LN-ESKD患者是在透析上启动的，并且在进步后多久未知 ESKD认为肾脏移植过程已开始，以及哪些社会经济和卫生系统障碍 阻碍了这种人群的这种治疗过渡。肾脏移植过程对于患者来说很复杂， 需要在包括初级保健在内的多个提供商和卫生系统之间进行协调的沟通 提供者，肾脏科医生，透析设施和移植中心。这项研究的总体目标 提案是表征成年人（≥18岁）患者的早期进入肾脏移植的特征 美国的ESKD通过评估社会经济和卫生系统流程对第一步的影响 肾脏移植过程，转介在移植中心进行评估。这项研究将利用 美国肾脏数据系统（USRDS）的ESKD患者的国家监视数据与 来自早期移植访问注册中心的新型患者推荐信息，该信息未在国家或未收集 区域监视系统，以检查进入移植的关键和必要的第一步。目标1 将估计1）ESKD的肾脏移植转诊的时间，将LN-ESKD患者与 ESKD患者使用COX比例风险模型与LN无关。 AIM 2将评估 LN-ESKD患者的肾脏移植和转诊的邻居贫困与转诊之间的关联 在ESKD开始之前访问肾脏专家的潜在中介作用。 AIM 3将使用跨分类 逻辑多级模型，以确定卫生系统因素的影响（包括透析设施和 ESKD患者肾脏移植转诊的移植中心特征）。从中的结果 拟议的研究项目将洞悉LN-肾脏移植转诊的流行病学 ESKD患者。此外，它将为治疗LN-ESKD患者的临床医生提供临床实践的信息。 强调及时推荐对肾脏移植的重要性，以减少患者在透析上的时间 以及在候补名单上的其他原因死亡。这些结果还将为有针对性的开发提供信息 在进入ESKD之前，采取干预措施，以改善肾脏科医生的机会并增强患者护理 透析设施和移植中心之间的医疗保健系统之间的协调。