Better Dialysis Facility Five-Star Rating is Associated with Increased Listing for Kidney Transplantation
1Surgery, Brigham and Women's Hospital, Boston, MA, 2Surgery, Beth Israel Deaconess Medical Center, Boston, MA, 3Surgery, Emory University, Atlanta, GA, 4Medicine, Boston Medical Center, Boston, MA
Meeting: 2021 American Transplant Congress
Abstract number: 686
Keywords: Waiting lists
Topic: Clinical Science » Public Policy » Non-Organ Specific: Public Policy & Allocation
Session Information
Session Name: Non-Organ Specific: Public Policy & Allocation
Session Type: Poster Abstract
Session Date & Time: None. Available on demand.
Location: Virtual
*Purpose: Improving the quality of dialysis care for patients with end stage kidney disease (ESKD) is a national clinical and policy priority: the Advancing American Kidney Health (AAKH) executive order established a target of 80% of new patients with ESKD receiving home dialysis or a kidney transplant by 2025. The Centers for Medicare & Medicaid Services (CMS) Five-Star Quality Rating is a public reporting program developed to help patients evaluate the quality of their dialysis center; it remains unknown if access to higher quality dialysis centers is related to higher likelihood of listing for transplant, which would help achieve the goals of AAKH. Therefore, empirical data would be helpful to assess whether increasing access to higher quality dialysis centers would potentially improve transplant listing rates.
*Methods: Using the incident cohort of patients beginning dialysis in 2013 from the United States Renal Data System, rates of listing for transplant within one year were assessed. Dialysis facility Five-Star Quality scores were obtained from Medicare Dialysis Facility Compare. We analyzed crude listing rates by Five-Star Quality ratings, and then estimated the probability of listing for transplant using a logistic regression model that controlled for patient- and facility-level factors.
*Results: Of the 100,740 incident dialysis patients, 7,851 (7.8%) were listed for transplantation within 1 year. Patients undergoing dialysis at 5-star dialysis centers were more likely to be listed than patients at the 1-star dialysis centers (9.2% vs 6.0%, P<0.001). Adjusting for both patient- and facility-level covariates, the odds of patient listing within 1 year were higher at 5 vs 1 star facilities (OR 1.40, P<0.001, Figure). Patients from rural (OR 0.81, P<0.001), for-profit (OR 0.69, P<0.011), and large (OR 0.81, P<0.001) dialysis facilities were less likely to be listed.
*Conclusions: There was a significant association between better dialysis facility quality, as measured by the CMS Five-Star Quality Ratings, and higher likelihood of listing for transplantation. Increasing patient access to higher quality dialysis facilities may increase access to transplantation and achieve the goals of AAKH.
To cite this abstract in AMA style:
Adler JT, Xiang L, Weissman JS, Rodrigue JR, Patzer RE, Waikar SS. Better Dialysis Facility Five-Star Rating is Associated with Increased Listing for Kidney Transplantation [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/better-dialysis-facility-five-star-rating-is-associated-with-increased-listing-for-kidney-transplantation/. Accessed May 16, 2025.« Back to 2021 American Transplant Congress