Purpose: Significant variation exists in Standardized Transplantation Ratios (STR) at the dialysis facility level, and GA has the lowest kidney transplant (KTx) rate in the nation. However, the STR is influenced by transplant center practices and organ supply and may not reflect variation in referral practices at dialysis facilities. We sought to describe variation in dialysis facility referral rates in Georgia (GA).

Methods: Patient-level kidney transplant referral data were collected from all three transplant centers in GA as part of the Reducing Disparities in Access to kidNey Transplantation (RaDIANT) Community Study. We linked data to United States Renal Data System data to obtain information about adult ESRD patients (age 18-69 years) initiating dialysis in GA (2005-2012) and not yet referred for KTx to obtain information about dialysis facility summary characteristics. The data were aggregated to the dialysis facility level and linked with the 2008-2011 Dialysis Facility Report to obtain facility characteristics.

Results: Among 311 dialysis facilities in GA treating 15,273 patients, 5,991 incident patients were referred to one of the three adult GA KTx centers from 2005 to 2012. The average annual KTx referral (referred within 1 year of dialysis start) was 3.8% (IQR: 1.0%-6.6%), and ranged from 0% to 33.3% (Figure). A total of 22% of facilities referred no patients to GA KTx centers over the nearly 7-year follow-up. Dialysis facility factors associated with lower referral included the average number of comorbidities, fewer patients dialyzing in a facility, and a higher percentage of males.

Conclusion: There is significant variation in dialysis facility level referral; the overall percentage of incident dialysis patients in GA who were referred within 1 year of dialysis start in 2005-2012 was only 3.8%. Interventions are needed to improve overall referral for KTx among dialysis facilities in GA.

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