BACKGROUND: Older patients show improved survival and quality of life following kidney transplantation (KT) compared to those who remain on dialysis, yet referral for KT occurs at 1/7th the rate of younger patients. Failure to discuss KT with older adults may lead to an age disparity in access to KT. As such, we assessed whether older patients undergoing hemodialysis discuss KT less frequently with medical professionals and social group members compared to younger counterparts.

METHODS: This cross-sectional analysis included 467 patients initiating hemodialysis at 26 dialysis centers in Baltimore, MD. Participants self-reported on whether they had discussed KT and the tone of those discussions (encouraging, neutral, discouraging) with medical professionals (nephrologist, primary care physician, dialysis staff) and social group members (significant other, family member, friend).

RESULTS: Participants aged ≥65 years were significantly less likely to have discussed KT with medical professionals (52% vs. 28%, p<0.001) or social group members (53% vs. 40%, p=0.014). Older participants were significantly less likely to describe conversations with nephrologists, PCPs, significant others, and family as encouraging (p<0.05). For each 5-yr increase in age the risk of failure to discuss KT increased for participants of all ages independent of other factors [Table 1]. Sex and race did not modify this relationship. The association between age and failure to discuss KT was stronger for discussions with medical professionals than with social group members for those aged ≥65 years (p for interaction = 0.01).

CONCLUSIONS: Older age is an independent correlate of failure to discuss and non-encouraging discussion about KT among patients undergoing hemodialysis, underscoring the age disparity in access to KT.

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