Oct. 29, 2009 Compared with veteran doctors, recent medical school graduates are more likely to refer chronic kidney disease (CKD) patients for kidney transplantation before their patients require dialysis, according to a paper being presented at the American Society of Nephrology's 42nd Annual Meeting and Scientific Exposition in San Diego, CA. These findings suggest that more recent medical training is associated with early referral. This is potentially due to a lack of knowledge about preemptive kidney transplantation among more veteran physicians.
Advanced CKD patients who receive a kidney transplant before they require dialysis (a "preemptive" transplantation) tend to live longer, have better transplanted kidney function and improved quality of life, than patients who require dialysis before a transplant. Therefore, the National Kidney Foundation guidelines published in 2007 recommend the promotion of early and preemptive kidney transplantation. However, only a fraction of kidney transplantations are performed preemptively. Referring physicians are an important element in the early referral of CKD patients leading to preemptive kidney transplantation. However, little is known about the characteristics of physicians who refer CKD patients in time for preemptive kidney transplantation.
Daniela Ladner, MD, MPH, (Northwestern University) and her colleagues analyzed information from all adult patients who received a living donor kidney transplant at their institution between January 2006 and May 2009. A total of 446 living donor kidney transplantations were analyzed; 137 were preemptive, while 309 were performed after initiation of dialysis. The investigators found that doctors closer to completion of medical school were significantly more likely to refer their CKD patients in time for preemptive transplantation. It is conceivable that the reason for this finding is that younger physicians are more likely to have learned about the benefits of preemptive kidney transplantation during their education. Hence they might be more prone to refer CKD early in their disease process, the authors concluded. "This is a single-center study and further investigation is necessary. However, based on our findings, educating veteran referring MDs about preemptive living donor kidney transplantation might increase the number of early referral to transplant centers," they noted.
The authors report no financial disclosures. Study co-authors include Vadim Lyuksemburg, BS; Raymond Chang, MA; Olivia Ross, MPH; Juan Carlos Caicedo, MD; Anton Skaro, MD, PhD; John Friedewald, MD; Michael Abecassis, MD, MBA; and Jane Holl, MD, MPH (Northwestern University).
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