Early Access to Kidney Transplantation among Patients with Lupus Nephritis

狼疮性肾炎患者早期接受肾移植

基本信息

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
项目类别：
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

项目摘要

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.

项目概要系统性红斑狼疮 (SLE) 是一种慢性、多系统自身免疫性疾病，可导致严重的称为狼疮性肾炎 (LN) 的肾脏表现，最终导致 LN 相关的终末期肾病 (LN-ESKD) 由于其高风险，SLE 患者中 LN-ESKD 的发生尤其值得关注。过早死亡及其对年轻患者和少数民族及较低种族患者的不成比例的影响研究表明，LN-ESKD 患者只有两种治疗选择。尽管如此，与长期透析相比，肾移植可以提供更大的生存益处。大多数 LN-ESKD 患者开始进行透析，并且在进展为多长时间后很大程度上尚不清楚 ESKD 肾移植过程的启动以及可能存在的经济和卫生系统障碍阻碍这一人群的治疗转变肾移植过程对患者来说很复杂，并且需要跨多个提供者和卫生系统（包括初级保健）进行协调沟通这项研究的总体目标。该提案旨在确定成年（≥18 岁）LN 患者早期接受肾移植的特征美国的 ESKD 通过评估社会经济和卫生系统流程对第一步的影响这项研究将利用肾移植过程中的转介进行评估。来自美国肾脏数据系统 (USRDS) 的 ESKD 患者国家监测数据与来自早期移植登记处的新患者转诊信息未在国家或地区收集区域监测系统检查这一关键且必要的移植目标 1 的第一步。将估计 1) 从 ESKD 转诊肾移植的时间开始将 LN-ESKD 患者与患有与 LN 无关的 ESKD 的患者，将使用 Cox 比例风险模型进行评估。邻里贫困与 LN-ESKD 患者转诊肾移植之间的关系在 ESKD 开始之前拜访肾脏专家的潜在中介作用目标 3 将使用交叉分类。逻辑多层次模型，以确定卫生系统因素（包括透析设施和移植中心的特点）关于 ESKD 患者转诊肾移植的结果。拟议的研究项目将深入了解 LN-肾移植转诊的流行病学此外，它还将通过以下方式为治疗 LN-ESKD 患者的临床实践提供信息。强调及时转诊肾移植以减少患者透析时间的重要性以及在候补名单上因其他原因死亡的情况。这些结果也将为制定有针对性的措施提供信息。在进展为 ESKD 之前改善与肾病专家就诊的机会并加强患者护理的干预措施透析机构和移植中心之间跨医疗保健系统的协调。