SAN DIEGO — Patients on dialysis with HIV are less likely to receive a kidney transplant than HIV-negative patients and time spent on dialysis may be a factor in this difference, according to data presented at ASN Kidney Week 2018.
“We know that patients with HIV have higher mortality on dialysis, but we haven’t fully studied what their access to transplants is from getting to that level, getting evaluated, then potentially getting listed,” Ashton A. Shaffer, a MD/PhD candidate at The Johns Hopkins University School of Medicine and the Bloomberg School of Public Health, said. “We wanted to look at HIV as exposure and look at their time to listing for kidney transplantation.”
Patients in the study with HIV tended to be young, African-American, male, had cognitive impairment and spent more time on dialysis before receiving kidney transplant. However, a patient’s diagnosis of being HIV negative or positive did not seem to affect the likelihood of being listed, independent of time.
“[When] we look at their cumulative instance of listing, we see that it’s lower for patients with HIV,” Shaffer said. “But the median time from evaluation to listing for patients without HIV was 133 days. For patients with HIV, it was 315 days.”
Using an adjusted Cox regression analysis, Shaffer and her colleagues were able to estimate the likelihood of a patient being listed for kidney transplant.
“When [you] further adjust for this difference of dialysis time of over a year more of waiting, for these patients, you see that this difference in access to listing is completely attenuated,” Shaffer said. “So, patients with HIV and without HIV have similar likelihood of getting listed once you account for this barrier.”
Adjusting for age, gender, African-American race, comorbidities and cognitive impairment, patients with HIV were less likely to be listed. However, additionally adjusting for time on dialysis attenuated this difference. According to Shaffer’s study, decreasing the time from the start of dialysis to transplant evaluation could increase the likelihood of patients being listed.
“[It] stood out that there seems to be a potential barrier from a systems level and that may be targeted interventions for earlier referral once they were on dialysis to be evaluated for transplant,” Shaffer said.
By Kristine Houck, MA, ELS, and Scott Buzby
Shaffer AA, et al. Abstract SA-PO091. Presented at: ASN Kidney Week; San Diego; Oct. 23-28, 2018.