A recently published study that investigated how patients on dialysis are referred for transplant found decision-making by dialysis facility staff — not whether a patient is necessarily a good candidate — has a greater influence on whether the referral takes place.

To track the factors that influence referral patterns, Rachel E. Patzer, PhD, MPH, of Emory University School of Medicine, and colleagues developed the standardized transplantation referral ratio to compute a standardized measure to monitor the transplant referral performance of dialysis facilities.

“In the past several years, the Centers for Medicare and Medicaid Services has focused on increasing referrals among dialysis facilities as part of the statement of work for the 18 end-stage renal disease networks. However, these data are not routinely collected and are not available to the public to determine whether some dialysis facilities are appropriately referring patients for kidney transplantation,” Patzer said in a press release about the study. “Monitoring transplant referrals among dialysis facilities could help drive quality improvement and increase access to kidney transplantation.”

The findings and details about the measure were published in the Clinical Journal of the American Society of Nephrology. According to the American Society of Nephrology, about 13% of U.S. patients who had kidney failure are waitlisted for transplantation, and of those, less than 20% get transplanted each year.

The researchers applied the standardized transplantation referral ratio to transplant referral data for 8,308 patients who had kidney failure within 249 dialysis facilities in Georgia that were linked with United States Renal Data System data from 2008 to 2011. The follow-up went through 2012.

Investigators found 77% of facilities had observed referrals as expected. Overall, 11% and 12% had standardized transplantation referral ratios that were significantly greater than or less than expected, respectively.

“Age, race, sex, and comorbid conditions were significantly associated with the likelihood of referral; however, most of the observed variation in dialysis facility referral performance was due to characteristics within a dialysis facility,” the authors reported in the press release.

In an accompanying editorial, kidney transplant recipient Kevin Fowler wrote that referrals ratios need to be collected by CMS so facilities that are lagging can be identified and corrective action taken.

“I am recommending immediate action,” he wrote. “I am requesting that the Centers for Medicare and Medicaid Services mandate that all dialysis facilities collect and record their kidney transplant referrals. This requirement is long overdue.”

Paul S, et al. Clin J Am Soc Nephrol. 2018;doi:10.2215/CJN.04690417.

Disclosures: The authors reported no relevant financial disclosures.